- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.37 / $245.82 / $269.22
| Professional | | $215.37 | $245.82 | $269.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.20 / $520.20 / $520.20
| Facility | | $520.20 | $520.20 | $520.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.66 / $180.66 / $180.66
| Professional | | $180.66 | $180.66 | $180.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.20 / $195.20 / $196.00
| Facility | | $195.20 | $195.20 | $196.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.88 / $174.00 / $260.13
| Professional | | $136.88 | $174.00 | $260.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.52 / $157.68 / $158.71
| Professional | | $153.52 | $157.68 | $158.71 |