- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.09 / $163.66 / $176.58
| Professional | | $130.09 | $163.66 | $176.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.94 / $568.55 / $673.11
| Facility | | $420.94 | $568.55 | $673.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.64 / $167.64 / $269.25
| Professional | | $167.64 | $167.64 | $269.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.29 / $170.29 / $170.29
| Facility | | $170.29 | $170.29 | $170.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.75 / $170.29 / $170.29
| Professional | | $144.75 | $170.29 | $170.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.94 / $181.27 / $247.56
| Professional | | $135.94 | $181.27 | $247.56 |