- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.28 / $192.16 / $320.75
| Professional | | $166.28 | $192.16 | $320.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.16 / $230.56 / $382.78
| Professional | | $178.16 | $230.56 | $382.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.74 / $228.74 / $228.74
| Facility | | $228.74 | $228.74 | $228.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.82 / $239.58 / $441.56
| Professional | | $193.82 | $239.58 | $441.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.14 / $331.47 / $578.05
| Professional | | $225.14 | $331.47 | $578.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.28 / $202.54 / $321.89
| Professional | | $166.28 | $202.54 | $321.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.80 / $250.62 / $405.44
| Professional | | $163.80 | $250.62 | $405.44 |