- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.97 / $202.65 / $251.08
| Professional | | $184.97 | $202.65 | $251.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.52 / $808.37 / $957.02
| Facility | | $598.52 | $808.37 | $957.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.47 / $222.47 / $372.06
| Professional | | $222.47 | $222.47 | $372.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.27 / $218.27 / $244.87
| Facility | | $218.27 | $218.27 | $244.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.34 / $218.27 / $218.27
| Professional | | $159.34 | $218.27 | $218.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.84 / $211.19 / $351.98
| Professional | | $152.84 | $211.19 | $351.98 |