- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.28 / $143.01 / $158.47
| Professional | | $135.28 | $143.01 | $158.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.25 / $227.61 / $247.36
| Facility | | $193.25 | $227.61 | $247.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.94 / $144.94 / $236.14
| Professional | | $144.94 | $144.94 | $236.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.54 / $571.54 / $571.54
| Facility | | $571.54 | $571.54 | $571.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.14 / $265.31 / $539.88
| Professional | | $99.14 | $265.31 | $539.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.17 / $115.95 / $278.72
| Professional | | $81.17 | $115.95 | $278.72 |