- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.30 / $155.80 / $275.92
| Professional | | $147.30 | $155.80 | $275.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.55 / $124.17 / $184.56
| Professional | | $105.55 | $124.17 | $184.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.23 / $814.23 / $814.23
| Facility | | $814.23 | $814.23 | $814.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.53 / $203.80 / $365.58
| Professional | | $145.53 | $203.80 | $365.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.89 / $209.24 / $338.01
| Professional | | $117.89 | $209.24 | $338.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.84 / $155.37 / $275.92
| Professional | | $101.84 | $155.37 | $275.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.05 / $230.62 / $300.77
| Professional | | $138.05 | $230.62 | $300.77 |