- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.26 / $115.29 / $145.50
| Professional | | $100.26 | $115.29 | $145.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.00 / $201.60 / $277.35
| Professional | | $151.00 | $201.60 | $277.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.68 / $130.68 / $143.84
| Facility | | $130.68 | $130.68 | $143.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.08 / $130.68 / $171.51
| Professional | | $111.08 | $130.68 | $171.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.29 / $133.96 / $300.01
| Facility | | $115.29 | $133.96 | $300.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.71 / $186.71 / $186.71
| Professional | | $186.71 | $186.71 | $186.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.84 / $73.80 / $131.05
| Professional | | $9.84 | $73.80 | $131.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.54 / $103.42 / $168.34
| Professional | | $71.54 | $103.42 | $168.34 |