- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.50 / $196.25 / $245.32
| Professional | | $160.50 | $196.25 | $245.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.42 / $139.03 / $191.06
| Facility | | $81.42 | $139.03 | $191.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.65 / $396.65 / $396.65
| Professional | | $396.65 | $396.65 | $396.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.00 / $145.00 / $145.00
| Facility | | $145.00 | $145.00 | $145.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.00 / $138.00 / $178.73
| Professional | | $133.00 | $138.00 | $178.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.12 / $146.21 / $176.00
| Professional | | $108.12 | $146.21 | $176.00 |