- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.41 / $123.16 / $165.14
| Professional | | $90.41 | $123.16 | $165.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.69 / $515.55 / $611.60
| Facility | | $446.69 | $515.55 | $611.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.31 / $156.63 / $288.58
| Professional | | $146.31 | $156.63 | $288.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.93 / $627.45 / $1,103.03
| Facility | | $257.93 | $627.45 | $1,103.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.16 / $277.54 / $367.93
| Professional | | $163.16 | $277.54 | $367.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.31 / $202.88 / $234.37
| Professional | | $139.31 | $202.88 | $234.37 |