- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $245.47 / $323.59
| Professional | | $141.25 | $245.47 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $354.81
| Professional | | $346.74 | $346.74 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $416.87
| Facility | | $245.47 | $245.47 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $245.47 / $426.58
| Professional | | $208.93 | $245.47 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $154.88 / $295.12
| Facility | | $19.95 | $154.88 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $204.17 / $316.23
| Professional | | $138.04 | $204.17 | $316.23 |