- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.05 / $308.08 / $395.28
| Professional | | $212.05 | $308.08 | $395.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.81 / $407.81 / $407.81
| Facility | | $407.81 | $407.81 | $407.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.64 / $407.81 / $407.81
| Professional | | $346.64 | $407.81 | $407.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.75 / $254.31 / $363.30
| Facility | | $183.75 | $254.31 | $363.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.71 / $408.21 / $525.29
| Professional | | $367.71 | $408.21 | $525.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.14 / $37.93 / $344.86
| Professional | | $24.14 | $37.93 | $344.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.34 / $264.25 / $366.02
| Professional | | $187.34 | $264.25 | $366.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.86 / $344.86 / $344.86
| Professional | | $344.86 | $344.86 | $344.86 |