- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $295.12
| Professional | | $165.96 | $223.87 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $398.11 / $537.03
| Professional | | $251.19 | $398.11 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $512.86 / $1,412.54
| Facility | | $288.40 | $512.86 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $158.49 / $245.47
| Professional | | $104.71 | $158.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $295.12
| Professional | | $107.15 | $173.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $316.23 / $660.69
| Professional | | $102.33 | $316.23 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |