- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.79 / $157.34 / $243.55
| Professional | | $143.79 | $157.34 | $243.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.26 / $633.60 / $1,036.33
| Facility | | $172.26 | $633.60 | $1,036.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.11 / $502.81 / $628.51
| Professional | | $377.11 | $502.81 | $628.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.41 / $258.16 / $494.41
| Facility | | $149.41 | $258.16 | $494.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.36 / $171.95 / $350.63
| Professional | | $143.36 | $171.95 | $350.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.88 / $170.24 / $268.80
| Professional | | $138.88 | $170.24 | $268.80 |