- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.82 / $185.25 / $239.32
| Professional | | $133.82 | $185.25 | $239.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.26 / $1,278.06 / $2,097.56
| Facility | | $925.26 | $1,278.06 | $2,097.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.29 / $205.56 / $292.48
| Professional | | $150.29 | $205.56 | $292.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.15 / $300.55 / $544.66
| Professional | | $187.15 | $300.55 | $544.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.85 / $229.65 / $414.30
| Professional | | $190.85 | $229.65 | $414.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.82 / $185.25 / $257.63
| Professional | | $133.82 | $185.25 | $257.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.13 / $235.81 / $385.64
| Professional | | $154.13 | $235.81 | $385.64 |