- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.33 / $266.33 / $376.93
| Professional | | $266.33 | $266.33 | $376.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.43 / $309.11 / $327.62
| Professional | | $258.43 | $309.11 | $327.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.40 / $219.78 / $295.63
| Facility | | $43.40 | $219.78 | $295.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.88 / $186.81 / $237.97
| Professional | | $35.88 | $186.81 | $237.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.77 / $362.77 / $362.77
| Professional | | $362.77 | $362.77 | $362.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.10 / $266.33 / $376.93
| Professional | | $187.10 | $266.33 | $376.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.96 / $236.21 / $421.61
| Professional | | $146.96 | $236.21 | $421.61 |