- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.76 / $153.71 / $200.57
| Professional | | $147.76 | $153.71 | $200.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.14 / $645.78 / $764.53
| Facility | | $478.14 | $645.78 | $764.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.06 / $177.72 / $297.23
| Professional | | $151.06 | $177.72 | $297.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.91 / $159.91 / $195.61
| Facility | | $159.91 | $159.91 | $195.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.74 / $116.74 / $116.74
| Professional | | $116.74 | $116.74 | $116.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.48 / $168.71 / $281.19
| Professional | | $112.48 | $168.71 | $281.19 |