- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $257.04 / $831.76
| Professional | | $181.97 | $257.04 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $549.54
| Professional | | $245.47 | $245.47 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $398.11
| Facility | | $251.19 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $251.19
| Professional | | $194.98 | $194.98 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $562.34
| Professional | | $467.74 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $263.03 / $831.76
| Professional | | $229.09 | $263.03 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $204.17 / $269.15
| Facility | | $128.82 | $204.17 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $467.74
| Professional | | $177.83 | $302.00 | $467.74 |