- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $218.78 / $457.09
| Professional | | $154.88 | $218.78 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $269.15
| Professional | | $138.04 | $229.09 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $316.23 / $436.52
| Professional | | $213.80 | $316.23 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $257.04 / $389.05
| Professional | | $169.82 | $257.04 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $489.78
| Professional | | $158.49 | $251.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $251.19 / $363.08
| Professional | | $169.82 | $251.19 | $363.08 |