- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.18 / $163.92 / $191.65
| Professional | | $141.18 | $163.92 | $191.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.84 / $617.05 / $730.52
| Facility | | $456.84 | $617.05 | $730.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.65 / $181.94 / $292.20
| Professional | | $154.65 | $181.94 | $292.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.54 / $170.54 / $186.91
| Facility | | $170.54 | $170.54 | $186.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.49 / $170.54 / $170.54
| Professional | | $124.49 | $170.54 | $170.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.69 / $184.54 / $268.67
| Professional | | $145.69 | $184.54 | $268.67 |