- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.65 / $159.34 / $171.92
| Professional | | $126.65 | $159.34 | $171.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.83 / $553.53 / $655.30
| Facility | | $409.83 | $553.53 | $655.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $152.33 / $254.76
| Professional | | $129.47 | $152.33 | $254.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.58 / $176.58 / $176.58
| Facility | | $176.58 | $176.58 | $176.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.90 / $225.62 / $244.34
| Professional | | $128.90 | $225.62 | $244.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.18 / $144.61 / $241.02
| Professional | | $112.18 | $144.61 | $241.02 |