- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.62 / $218.44 / $532.59
| Professional | | $159.62 | $218.44 | $532.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.48 / $286.51 / $823.36
| Professional | | $227.48 | $286.51 | $823.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.74 / $315.74 / $699.00
| Facility | | $315.74 | $315.74 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.71 / $320.14 / $1,009.52
| Professional | | $205.71 | $320.14 | $1,009.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.48 / $580.63 / $1,117.44
| Professional | | $232.48 | $580.63 | $1,117.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.62 / $223.63 / $632.03
| Professional | | $159.62 | $223.63 | $632.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.08 / $260.25 / $646.33
| Professional | | $181.08 | $260.25 | $646.33 |