- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.62 / $189.11 / $970.80
| Professional | | $159.62 | $189.11 | $970.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.97 / $294.97 / $294.97
| Facility | | $294.97 | $294.97 | $294.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.64 / $314.27 / $901.53
| Professional | | $186.64 | $314.27 | $901.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.96 / $316.55 / $506.72
| Facility | | $181.96 | $316.55 | $506.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.04 / $469.84 / $1,213.27
| Professional | | $235.04 | $469.84 | $1,213.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.74 / $312.62 / $532.54
| Professional | | $254.74 | $312.62 | $532.54 |