- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.64 / $222.24 / $239.78
| Professional | | $176.64 | $222.24 | $239.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.61 / $772.05 / $914.01
| Facility | | $571.61 | $772.05 | $914.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.59 / $212.46 / $355.34
| Professional | | $180.59 | $212.46 | $355.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.94 / $267.94 / $267.94
| Facility | | $267.94 | $267.94 | $267.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.60 / $267.94 / $267.94
| Professional | | $195.60 | $267.94 | $267.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.29 / $257.70 / $336.16
| Professional | | $182.29 | $257.70 | $336.16 |