- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.78 / $144.75 / $305.70
| Professional | | $113.78 | $144.75 | $305.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.26 / $164.74 / $247.10
| Facility | | $113.26 | $164.74 | $247.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.84 / $151.01 / $159.54
| Professional | | $81.84 | $151.01 | $159.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.16 / $162.16 / $162.16
| Facility | | $162.16 | $162.16 | $162.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.54 / $172.31 / $325.18
| Professional | | $132.54 | $172.31 | $325.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.03 / $286.88 / $467.18
| Professional | | $208.03 | $286.88 | $467.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.36 / $156.41 / $220.81
| Professional | | $106.36 | $156.41 | $220.81 |