- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.10 / $221.29 / $310.48
| Professional | | $188.10 | $221.29 | $310.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.39 / $292.39 / $306.04
| Professional | | $292.39 | $292.39 | $306.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.52 / $209.52 / $290.14
| Facility | | $209.52 | $209.52 | $290.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.09 / $178.09 / $209.52
| Professional | | $178.09 | $178.09 | $209.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.19 / $415.12 / $526.37
| Professional | | $356.19 | $415.12 | $526.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.21 / $223.38 / $340.61
| Professional | | $157.21 | $223.38 | $340.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.55 / $285.55 / $366.01
| Professional | | $285.55 | $285.55 | $366.01 |