- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.76 / $377.29 / $377.29
| Professional | | $244.76 | $377.29 | $377.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.34 / $268.11 / $420.56
| Professional | | $252.34 | $268.11 | $420.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.38 / $373.38 / $411.73
| Facility | | $373.38 | $373.38 | $411.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.37 / $317.37 / $373.38
| Professional | | $317.37 | $317.37 | $373.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.56 / $453.56 / $453.56
| Professional | | $453.56 | $453.56 | $453.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.42 / $377.29 / $377.29
| Professional | | $315.42 | $377.29 | $377.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.32 / $315.81 / $642.70
| Professional | | $186.32 | $315.81 | $642.70 |