- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.66 / $184.91 / $204.51
| Professional | | $150.66 | $184.91 | $204.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.50 / $658.43 / $779.51
| Facility | | $487.50 | $658.43 | $779.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.15 / $194.15 / $311.81
| Professional | | $194.15 | $194.15 | $311.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.45 / $265.56 / $265.56
| Facility | | $199.45 | $265.56 | $265.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.86 / $265.56 / $265.56
| Professional | | $193.86 | $265.56 | $265.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.60 / $204.80 / $286.70
| Professional | | $153.60 | $204.80 | $286.70 |