- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.77 / $179.18 / $298.14
| Professional | | $118.77 | $179.18 | $298.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.16 / $238.16 / $238.16
| Facility | | $238.16 | $238.16 | $238.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.44 / $238.16 / $382.13
| Professional | | $202.44 | $238.16 | $382.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.21 / $354.21 / $356.71
| Professional | | $354.21 | $354.21 | $356.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.91 / $257.91 / $257.91
| Professional | | $257.91 | $257.91 | $257.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.09 / $191.82 / $247.78
| Professional | | $155.09 | $191.82 | $247.78 |