- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.28 / $201.12 / $407.43
| Professional | | $183.28 | $201.12 | $407.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.67 / $393.82 / $393.82
| Professional | | $390.67 | $393.82 | $393.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.67 / $390.67 / $390.67
| Facility | | $390.67 | $390.67 | $390.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.52 / $334.75 / $390.67
| Professional | | $185.52 | $334.75 | $390.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.54 / $241.93 / $390.25
| Facility | | $193.54 | $241.93 | $390.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.60 / $376.34 / $508.06
| Professional | | $232.60 | $376.34 | $508.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.49 / $373.52 / $422.75
| Professional | | $313.49 | $373.52 | $422.75 |