- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.02 / $335.45 / $382.53
| Professional | | $306.02 | $335.45 | $382.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.00 / $221.00 / $221.00
| Facility | | $221.00 | $221.00 | $221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $375.17 / $849.56
| Professional | | $200.00 | $375.17 | $849.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.00 / $279.45 / $355.44
| Facility | | $221.00 | $279.45 | $355.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $271.18 / $375.17
| Professional | | $200.00 | $271.18 | $375.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.50 / $315.39 / $436.40
| Professional | | $195.50 | $315.39 | $436.40 |