- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $234.42 / $331.13
| Professional | | $190.55 | $234.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $245.47 / $281.84
| Professional | | $223.87 | $245.47 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $169.82 / $489.78
| Professional | | $141.25 | $169.82 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $316.23 / $416.87
| Professional | | $275.42 | $316.23 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $208.93
| Facility | | $114.82 | $114.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $123.03 / $223.87
| Professional | | $114.82 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |