- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.16 / $230.44 / $248.62
| Professional | | $183.16 | $230.44 | $248.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.67 / $800.48 / $947.67
| Facility | | $592.67 | $800.48 | $947.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.63 / $236.03 / $379.08
| Professional | | $200.63 | $236.03 | $379.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.01 / $252.01 / $252.01
| Facility | | $252.01 | $252.01 | $252.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.97 / $252.01 / $252.01
| Professional | | $183.97 | $252.01 | $252.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.22 / $209.13 / $348.55
| Professional | | $162.22 | $209.13 | $348.55 |