- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.07 / $142.38 / $192.61
| Professional | | $106.07 | $142.38 | $192.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.33 / $155.33 / $162.66
| Facility | | $155.33 | $155.33 | $162.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.05 / $153.75 / $380.90
| Professional | | $125.05 | $153.75 | $380.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.37 / $183.37 / $229.22
| Professional | | $183.37 | $183.37 | $229.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.16 / $227.55 / $339.12
| Professional | | $148.16 | $227.55 | $339.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.69 / $188.92 / $314.45
| Professional | | $115.69 | $188.92 | $314.45 |