- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.53 / $122.44 / $180.91
| Professional | | $93.53 | $122.44 | $180.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.96 / $251.72 / $251.72
| Professional | | $213.96 | $251.72 | $251.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.64 / $235.06 / $293.82
| Professional | | $185.64 | $235.06 | $293.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.07 / $134.72 / $685.02
| Facility | | $117.07 | $134.72 | $685.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.97 / $187.35 / $245.85
| Professional | | $157.97 | $187.35 | $245.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.47 / $160.47 / $160.47
| Facility | | $160.47 | $160.47 | $160.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.58 / $192.42 / $229.99
| Professional | | $159.58 | $192.42 | $229.99 |