- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.56 / $200.08 / $275.37
| Professional | | $142.56 | $200.08 | $275.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.79 / $1,432.13 / $2,350.42
| Facility | | $1,036.79 | $1,432.13 | $2,350.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.55 / $228.40 / $328.74
| Professional | | $167.55 | $228.40 | $328.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.92 / $336.44 / $597.46
| Professional | | $207.92 | $336.44 | $597.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.52 / $256.94 / $463.51
| Professional | | $213.52 | $256.94 | $463.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.56 / $200.08 / $288.56
| Professional | | $142.56 | $200.08 | $288.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.37 / $252.26 / $416.51
| Professional | | $179.37 | $252.26 | $416.51 |