- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.34 / $177.34 / $286.11
| Professional | | $177.34 | $177.34 | $286.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.65 / $284.16 / $526.74
| Facility | | $239.65 | $284.16 | $526.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.25 / $188.25 / $207.07
| Professional | | $188.25 | $188.25 | $207.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.31 / $166.31 / $260.27
| Facility | | $166.31 | $166.31 | $260.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.31 / $166.31 / $196.56
| Professional | | $166.31 | $166.31 | $196.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.06 / $197.06 / $197.06
| Professional | | $197.06 | $197.06 | $197.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.28 / $177.34 / $286.11
| Professional | | $136.28 | $177.34 | $286.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.23 / $184.32 / $452.24
| Professional | | $87.23 | $184.32 | $452.24 |