- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.59 / $238.53 / $257.35
| Professional | | $189.59 | $238.53 | $257.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.48 / $828.58 / $980.93
| Facility | | $613.48 | $828.58 | $980.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.67 / $244.32 / $392.39
| Professional | | $207.67 | $244.32 | $392.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.80 / $286.80 / $286.80
| Facility | | $286.80 | $286.80 | $286.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.36 / $209.36 / $209.36
| Professional | | $209.36 | $209.36 | $209.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.65 / $247.79 / $360.78
| Professional | | $195.65 | $247.79 | $360.78 |