- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $363.08 / $524.81
| Professional | | $295.12 | $363.08 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $51.29
| Professional | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Facility | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $346.74 / $407.38
| Professional | | $46.77 | $346.74 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $165.96 / $354.81
| Facility | | $23.44 | $165.96 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $204.17 / $380.19
| Professional | | $186.21 | $204.17 | $380.19 |