- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.71 / $184.07 / $207.29
| Professional | | $152.71 | $184.07 | $207.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.15 / $667.43 / $790.16
| Facility | | $494.15 | $667.43 | $790.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.04 / $228.28 / $316.06
| Professional | | $194.04 | $228.28 | $316.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.97 / $220.51 / $220.51
| Facility | | $201.97 | $220.51 | $220.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.97 / $220.51 / $220.51
| Professional | | $160.97 | $220.51 | $220.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.59 / $203.86 / $290.61
| Professional | | $157.59 | $203.86 | $290.61 |