- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.38 / $246.39 / $303.07
| Professional | | $136.38 | $246.39 | $303.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.94 / $197.94 / $217.08
| Facility | | $197.94 | $197.94 | $217.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.50 / $197.94 / $211.02
| Professional | | $144.50 | $197.94 | $211.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.03 / $243.80 / $346.12
| Facility | | $102.03 | $243.80 | $346.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.51 / $328.81 / $346.12
| Professional | | $311.51 | $328.81 | $346.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $255.43 / $304.20
| Professional | | $30.00 | $255.43 | $304.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.07 / $338.01 / $507.02
| Facility | | $303.07 | $338.01 | $507.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.28 / $250.95 / $363.43
| Professional | | $242.28 | $250.95 | $363.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.12 / $158.03 / $243.53
| Professional | | $146.12 | $158.03 | $243.53 |