- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.08 / $190.42 / $210.51
| Professional | | $155.08 | $190.42 | $210.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.83 / $677.79 / $802.43
| Facility | | $501.83 | $677.79 | $802.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.55 / $186.53 / $311.95
| Professional | | $158.55 | $186.53 | $311.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.09 / $205.09 / $205.30
| Facility | | $205.09 | $205.09 | $205.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.72 / $205.09 / $205.09
| Professional | | $149.72 | $205.09 | $205.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.65 / $184.53 / $295.13
| Professional | | $138.65 | $184.53 | $295.13 |