- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.69 / $155.36 / $204.56
| Professional | | $150.69 | $155.36 | $204.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.65 / $658.63 / $779.74
| Facility | | $487.65 | $658.63 | $779.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.26 / $181.26 / $303.14
| Professional | | $181.26 | $181.26 | $303.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.63 / $161.63 / $199.50
| Facility | | $161.63 | $161.63 | $199.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.99 / $161.63 / $161.63
| Professional | | $117.99 | $161.63 | $161.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.54 / $170.54 / $170.54
| Facility | | $170.54 | $170.54 | $170.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.52 / $193.94 / $286.77
| Professional | | $155.52 | $193.94 | $286.77 |