- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.98 / $186.06 / $382.50
| Professional | | $86.98 | $186.06 | $382.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.88 / $316.52 / $316.52
| Professional | | $284.88 | $316.52 | $316.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.52 / $316.52 / $316.52
| Facility | | $316.52 | $316.52 | $316.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.33 / $251.65 / $546.26
| Professional | | $182.33 | $251.65 | $546.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.48 / $235.82 / $401.17
| Facility | | $186.48 | $235.82 | $401.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.42 / $410.55 / $534.61
| Professional | | $228.42 | $410.55 | $534.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.27 / $292.88 / $345.80
| Professional | | $256.27 | $292.88 | $345.80 |