- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.90 / $130.25 / $138.32
| Professional | | $101.90 | $130.25 | $138.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.74 / $445.35 / $527.24
| Facility | | $329.74 | $445.35 | $527.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.18 / $122.56 / $204.98
| Professional | | $104.18 | $122.56 | $204.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.88 / $135.51 / $135.51
| Facility | | $134.88 | $135.51 | $135.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.92 / $135.51 / $135.51
| Professional | | $98.92 | $135.51 | $135.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.70 / $124.66 / $193.91
| Professional | | $91.70 | $124.66 | $193.91 |