- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $213.80 / $389.05
| Professional | | $173.78 | $213.80 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $288.40 / $467.74
| Professional | | $158.49 | $288.40 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $691.83
| Facility | | $331.13 | $331.13 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $281.84 / $512.86
| Professional | | $199.53 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $562.34
| Professional | | $218.78 | $331.13 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $602.56
| Professional | | $181.97 | $281.84 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $269.15 / $436.52
| Professional | | $190.55 | $269.15 | $436.52 |