- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.30 / $129.97 / $140.22
| Professional | | $103.30 | $129.97 | $140.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.28 / $451.47 / $534.49
| Facility | | $334.28 | $451.47 | $534.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.61 / $124.25 / $207.79
| Professional | | $105.61 | $124.25 | $207.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.22 / $135.22 / $135.22
| Facility | | $135.22 | $135.22 | $135.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.72 / $183.37 / $198.58
| Professional | | $98.72 | $183.37 | $198.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.50 / $117.95 / $196.58
| Professional | | $91.50 | $117.95 | $196.58 |