- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.76 / $352.38 / $413.87
| Professional | | $190.76 | $352.38 | $413.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.16 / $301.58 / $426.34
| Professional | | $274.16 | $301.58 | $426.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.17 / $175.28 / $175.28
| Professional | | $171.17 | $175.28 | $175.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.57 / $463.43 / $823.30
| Facility | | $347.57 | $463.43 | $823.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.82 / $240.74 / $742.28
| Professional | | $151.82 | $240.74 | $742.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.63 / $235.33 / $499.93
| Professional | | $142.63 | $235.33 | $499.93 |