- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.54 / $162.27 / $164.32
| Professional | | $119.54 | $162.27 | $164.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.83 / $522.47 / $618.54
| Facility | | $386.83 | $522.47 | $618.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.94 / $154.05 / $247.42
| Professional | | $130.94 | $154.05 | $247.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.25 / $170.96 / $170.96
| Facility | | $158.25 | $170.96 | $170.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.80 / $124.80 / $124.80
| Professional | | $124.80 | $124.80 | $124.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.68 / $146.25 / $227.49
| Professional | | $115.68 | $146.25 | $227.49 |