- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.52 / $144.52 / $157.19
| Professional | | $144.52 | $144.52 | $157.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $476.21 / $657.79 / $1,079.57
| Facility | | $476.21 | $657.79 | $1,079.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.94 / $161.05 / $236.54
| Professional | | $130.94 | $161.05 | $236.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.22 / $204.89 / $291.58
| Professional | | $154.22 | $204.89 | $291.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.75 / $177.89 / $333.76
| Professional | | $153.75 | $177.89 | $333.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.52 / $144.52 / $206.02
| Professional | | $144.52 | $144.52 | $206.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.34 / $234.78 / $283.36
| Professional | | $119.34 | $234.78 | $283.36 |