- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.43 / $195.83 / $314.70
| Professional | | $171.43 | $195.83 | $314.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.09 / $231.45 / $389.14
| Professional | | $198.09 | $231.45 | $389.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.54 / $234.54 / $234.54
| Facility | | $234.54 | $234.54 | $234.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.31 / $183.31 / $183.31
| Professional | | $183.31 | $183.31 | $183.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.73 / $297.89 / $585.66
| Professional | | $249.73 | $297.89 | $585.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.06 / $195.83 / $314.70
| Professional | | $168.06 | $195.83 | $314.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.65 / $280.52 / $409.10
| Professional | | $203.65 | $280.52 | $409.10 |