- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.68 / $133.94 / $135.63
| Professional | | $98.68 | $133.94 | $135.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.30 / $431.25 / $510.55
| Facility | | $319.30 | $431.25 | $510.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.16 / $127.16 / $204.23
| Professional | | $127.16 | $127.16 | $204.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.63 / $141.12 / $141.12
| Facility | | $130.63 | $141.12 | $141.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.02 / $103.02 / $103.02
| Professional | | $103.02 | $103.02 | $103.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.22 / $112.67 / $187.78
| Professional | | $88.22 | $112.67 | $187.78 |