- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.04 / $274.62 / $346.26
| Professional | | $191.04 | $274.62 | $346.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.09 / $293.45 / $307.75
| Professional | | $232.09 | $293.45 | $307.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.34 / $240.34 / $240.34
| Facility | | $240.34 | $240.34 | $240.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.46 / $240.34 / $247.55
| Professional | | $36.46 | $240.34 | $247.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.25 / $355.47 / $2,207.17
| Facility | | $182.25 | $355.47 | $2,207.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.47 / $225.42 / $423.36
| Professional | | $158.47 | $225.42 | $423.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.41 / $225.42 / $397.14
| Professional | | $170.41 | $225.42 | $397.14 |