- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.70 / $193.70 / $241.09
| Professional | | $193.70 | $193.70 | $241.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.88 / $156.16 / $156.16
| Professional | | $132.88 | $156.16 | $156.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.05 / $712.05 / $712.05
| Facility | | $712.05 | $712.05 | $712.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.04 / $228.65 / $273.68
| Professional | | $194.04 | $228.65 | $273.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.63 / $181.23 / $278.02
| Professional | | $156.63 | $181.23 | $278.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.70 / $193.70 / $287.50
| Professional | | $193.70 | $193.70 | $287.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.80 / $216.99 / $270.51
| Professional | | $128.80 | $216.99 | $270.51 |