- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.75 / $154.82 / $204.09
| Professional | | $140.75 | $154.82 | $204.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.64 / $169.82 / $177.79
| Facility | | $168.64 | $169.82 | $177.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.79 / $177.79 / $296.32
| Facility | | $177.79 | $177.79 | $296.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.82 / $161.82 / $161.82
| Professional | | $161.82 | $161.82 | $161.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.79 / $177.79 / $296.32
| Facility | | $177.79 | $177.79 | $296.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.82 / $161.82 / $161.82
| Professional | | $161.82 | $161.82 | $161.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.26 / $173.08 / $266.25
| Professional | | $137.26 | $173.08 | $266.25 |