- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $190.55 / $354.81
| Professional | | $151.36 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $288.40 / $436.52
| Professional | | $147.91 | $288.40 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $457.09
| Facility | | $309.03 | $309.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $263.03 / $512.86
| Professional | | $181.97 | $263.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $562.34
| Professional | | $213.80 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $245.47 / $501.19
| Professional | | $165.96 | $245.47 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $239.88 / $407.38
| Professional | | $165.96 | $239.88 | $407.38 |