- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.17 / $252.10 / $315.13
| Professional | | $206.17 | $252.10 | $315.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.73 / $178.68 / $245.63
| Facility | | $127.73 | $178.68 | $245.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.57 / $511.57 / $511.57
| Professional | | $511.57 | $511.57 | $511.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.00 / $182.00 / $182.00
| Facility | | $182.00 | $182.00 | $182.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.00 / $170.00 / $229.77
| Professional | | $166.00 | $170.00 | $229.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.02 / $187.98 / $191.13
| Professional | | $139.02 | $187.98 | $191.13 |