- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $213.80 / $407.38
| Professional | | $173.78 | $213.80 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $616.60
| Facility | | $218.78 | $218.78 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $426.58
| Professional | | $158.49 | $158.49 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $190.55 / $457.09
| Facility | | $114.82 | $190.55 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $269.15
| Professional | | $112.20 | $186.21 | $269.15 |