- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.80 / $228.81 / $309.68
| Professional | | $160.80 | $228.81 | $309.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.32 / $307.27 / $426.85
| Professional | | $214.32 | $307.27 | $426.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.79 / $302.79 / $456.00
| Facility | | $302.79 | $302.79 | $456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.21 / $333.79 / $570.28
| Professional | | $209.21 | $333.79 | $570.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.65 / $321.10 / $569.91
| Professional | | $224.65 | $321.10 | $569.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.91 / $228.81 / $320.08
| Professional | | $184.91 | $228.81 | $320.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.48 / $351.68 / $531.79
| Professional | | $244.48 | $351.68 | $531.79 |