- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.87 / $227.90 / $282.58
| Professional | | $125.87 | $227.90 | $282.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.63 / $909.82 / $1,077.11
| Facility | | $673.63 | $909.82 | $1,077.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.39 / $250.39 / $418.75
| Professional | | $250.39 | $250.39 | $418.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.12 / $237.10 / $275.33
| Facility | | $225.12 | $237.10 | $275.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.08 / $225.12 / $237.10
| Professional | | $173.08 | $225.12 | $237.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.89 / $237.70 / $396.16
| Professional | | $171.89 | $237.70 | $396.16 |