- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $144.54 / $204.17
| Professional | | $123.03 | $144.54 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $165.96 / $223.87
| Facility | | $141.25 | $165.96 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $177.83
| Professional | | $104.71 | $151.36 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $398.11 / $537.03
| Facility | | $223.87 | $398.11 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $194.98 / $338.84
| Professional | | $141.25 | $194.98 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $281.84 / $331.13
| Facility | | $245.47 | $281.84 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $147.91 / $218.78
| Professional | | $102.33 | $147.91 | $218.78 |