- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.75 / $156.66 / $204.63
| Professional | | $150.75 | $156.66 | $204.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.81 / $658.83 / $779.97
| Facility | | $487.81 | $658.83 | $779.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.56 / $225.36 / $311.99
| Professional | | $191.56 | $225.36 | $311.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.78 / $190.78 / $199.56
| Facility | | $190.78 | $190.78 | $199.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.27 / $190.78 / $190.78
| Professional | | $139.27 | $190.78 | $190.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.16 / $172.12 / $286.87
| Professional | | $118.16 | $172.12 | $286.87 |