- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.52 / $184.50 / $269.22
| Professional | | $132.52 | $184.50 | $269.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.21 / $146.47 / $213.86
| Facility | | $124.21 | $146.47 | $213.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.79 / $575.40 / $575.40
| Professional | | $407.79 | $575.40 | $575.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.00 / $188.62 / $188.62
| Facility | | $155.00 | $188.62 | $188.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.63 / $188.62 / $256.27
| Professional | | $137.63 | $188.62 | $256.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.18 / $208.87 / $212.36
| Professional | | $154.18 | $208.87 | $212.36 |