- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.54 / $191.21 / $224.71
| Professional | | $165.54 | $191.21 | $224.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.69 / $723.53 / $856.57
| Facility | | $535.69 | $723.53 | $856.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.33 / $213.33 / $342.64
| Professional | | $213.33 | $213.33 | $342.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.14 / $221.07 / $221.07
| Facility | | $219.14 | $221.07 | $221.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.38 / $221.07 / $221.07
| Professional | | $161.38 | $221.07 | $221.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.83 / $216.38 / $315.04
| Professional | | $158.83 | $216.38 | $315.04 |