- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.02 / $266.33 / $391.98
| Professional | | $254.02 | $266.33 | $391.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.16 / $212.87 / $312.24
| Professional | | $181.16 | $212.87 | $312.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.64 / $531.64 / $531.64
| Facility | | $531.64 | $531.64 | $531.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.66 / $355.22 / $530.94
| Professional | | $253.66 | $355.22 | $530.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.21 / $315.33 / $490.65
| Professional | | $203.21 | $315.33 | $490.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.02 / $254.02 / $391.98
| Professional | | $254.02 | $254.02 | $391.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.38 / $324.58 / $448.44
| Professional | | $225.38 | $324.58 | $448.44 |