- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.26 / $211.40 / $250.56
| Professional | | $178.26 | $211.40 | $250.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.66 / $775.90 / $896.28
| Facility | | $579.66 | $775.90 | $896.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.65 / $218.65 / $472.34
| Professional | | $218.65 | $218.65 | $472.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.52 / $964.52 / $1,695.57
| Facility | | $840.52 | $964.52 | $1,695.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.76 / $420.52 / $527.22
| Professional | | $227.76 | $420.52 | $527.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.24 / $208.27 / $352.54
| Professional | | $154.24 | $208.27 | $352.54 |