- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.32 / $167.98 / $216.26
| Professional | | $159.32 | $167.98 | $216.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.54 / $696.31 / $824.35
| Facility | | $515.54 | $696.31 | $824.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.88 / $191.63 / $320.48
| Professional | | $162.88 | $191.63 | $320.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.77 / $174.77 / $210.90
| Facility | | $174.77 | $174.77 | $210.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.58 / $174.77 / $174.77
| Professional | | $127.58 | $174.77 | $174.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.41 / $208.24 / $303.19
| Professional | | $164.41 | $208.24 | $303.19 |