- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.14 / $254.64 / $310.56
| Professional | | $177.14 | $254.64 | $310.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.38 / $210.49 / $254.49
| Professional | | $180.38 | $210.49 | $254.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.16 / $238.16 / $238.16
| Facility | | $238.16 | $238.16 | $238.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.44 / $238.16 / $274.02
| Professional | | $202.44 | $238.16 | $274.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.15 / $291.38 / $1,682.37
| Facility | | $106.15 | $291.38 | $1,682.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.22 / $193.43 / $394.59
| Professional | | $136.22 | $193.43 | $394.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.02 / $193.43 / $286.74
| Professional | | $137.02 | $193.43 | $286.74 |