- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.66 / $191.06 / $267.83
| Professional | | $150.66 | $191.06 | $267.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.72 / $690.51 / $1,484.11
| Facility | | $685.72 | $690.51 | $1,484.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.28 / $273.52 / $816.44
| Professional | | $225.28 | $273.52 | $816.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.19 / $222.61 / $572.87
| Professional | | $163.19 | $222.61 | $572.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.41 / $288.94 / $572.87
| Professional | | $202.41 | $288.94 | $572.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.07 / $243.39 / $806.49
| Professional | | $208.07 | $243.39 | $806.49 |