- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.94 / $219.84 / $222.62
| Professional | | $161.94 | $219.84 | $222.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.08 / $707.85 / $838.01
| Facility | | $524.08 | $707.85 | $838.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.40 / $208.71 / $335.20
| Professional | | $177.40 | $208.71 | $335.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.41 / $239.78 / $239.78
| Facility | | $214.41 | $239.78 | $239.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.04 / $239.78 / $239.78
| Professional | | $175.04 | $239.78 | $239.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.14 / $236.27 / $308.20
| Professional | | $167.14 | $236.27 | $308.20 |