- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $190.55 / $346.74
| Professional | | $151.36 | $190.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $398.11
| Professional | | $151.36 | $257.04 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $691.83
| Facility | | $288.40 | $288.40 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $426.58
| Professional | | $173.78 | $239.88 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $478.63
| Professional | | $181.97 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $245.47 / $512.86
| Professional | | $158.49 | $245.47 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $234.42 / $380.19
| Professional | | $165.96 | $234.42 | $380.19 |