- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.82 / $247.10 / $367.79
| Professional | | $172.82 | $247.10 | $367.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.18 / $393.87 / $474.97
| Professional | | $296.18 | $393.87 | $474.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.39 / $375.87 / $429.56
| Professional | | $354.39 | $375.87 | $429.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $161.84 / $349.37
| Professional | | $32.34 | $161.84 | $349.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $270.73 / $270.73 / $270.73
| Facility | 26 | $270.73 | $270.73 | $270.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.48 / $345.27 / $405.91
| Professional | | $293.48 | $345.27 | $405.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.17 / $300.72 / $494.89
| Professional | | $220.17 | $300.72 | $494.89 |