- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.26 / $273.50 / $372.60
| Professional | | $190.26 | $273.50 | $372.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.14 / $323.57 / $372.29
| Professional | | $272.14 | $323.57 | $372.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.97 / $265.97 / $265.97
| Facility | | $265.97 | $265.97 | $265.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.07 / $226.07 / $265.97
| Professional | | $226.07 | $226.07 | $265.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.26 / $413.30 / $1,908.97
| Facility | | $190.26 | $413.30 | $1,908.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.40 / $262.35 / $474.76
| Professional | | $187.40 | $262.35 | $474.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.40 / $235.34 / $474.76
| Professional | | $187.40 | $235.34 | $474.76 |