- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.40 / $132.68 / $158.36
| Professional | | $14.40 | $132.68 | $158.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.87 / $129.87 / $129.87
| Professional | | $129.87 | $129.87 | $129.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.01 / $262.37 / $311.88
| Facility | | $223.01 | $262.37 | $311.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.55 / $206.60 / $262.37
| Professional | | $129.55 | $206.60 | $262.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.21 / $137.24 / $262.37
| Facility | | $86.21 | $137.24 | $262.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.81 / $223.01 / $298.10
| Professional | | $155.81 | $223.01 | $298.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.16 / $167.09 / $170.11
| Professional | | $123.16 | $167.09 | $170.11 |