- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.63 / $141.36 / $141.36
| Professional | | $120.63 | $141.36 | $141.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.61 / $462.20 / $758.57
| Facility | | $334.61 | $462.20 | $758.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.22 / $157.22 / $206.75
| Professional | | $157.22 | $157.22 | $206.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.11 / $130.11 / $130.11
| Facility | | $130.11 | $130.11 | $130.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.49 / $169.18 / $325.13
| Professional | | $124.49 | $169.18 | $325.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.07 / $140.30 / $246.55
| Professional | | $118.07 | $140.30 | $246.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.63 / $141.36 / $141.36
| Professional | | $120.63 | $141.36 | $141.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.14 / $350.22 / $520.54
| Professional | | $216.14 | $350.22 | $520.54 |