- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.61 / $274.16 / $331.42
| Professional | | $201.61 | $274.16 | $331.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.68 / $354.68 / $491.25
| Professional | | $354.68 | $354.68 | $491.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.30 / $204.34 / $358.46
| Facility | | $181.30 | $204.34 | $358.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.34 / $374.12 / $428.54
| Professional | | $204.34 | $374.12 | $428.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.65 / $391.53 / $489.42
| Professional | | $293.65 | $391.53 | $489.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.50 / $265.55 / $407.51
| Professional | | $241.50 | $265.55 | $407.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.80 / $416.80 / $416.80
| Professional | | $416.80 | $416.80 | $416.80 |