- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.90 / $236.97 / $236.97
| Professional | | $198.90 | $236.97 | $236.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.08 / $873.09 / $1,432.92
| Facility | | $632.08 | $873.09 | $1,432.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.20 / $246.55 / $367.52
| Professional | | $207.20 | $246.55 | $367.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.35 / $334.81 / $438.59
| Professional | | $243.35 | $334.81 | $438.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.37 / $272.32 / $510.94
| Professional | | $235.37 | $272.32 | $510.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.90 / $236.97 / $315.39
| Professional | | $198.90 | $236.97 | $315.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.89 / $245.66 / $526.83
| Professional | | $210.89 | $245.66 | $526.83 |