- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.32 / $187.39 / $220.22
| Professional | | $167.32 | $187.39 | $220.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.92 / $202.49 / $272.45
| Facility | | $24.92 | $202.49 | $272.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.81 / $204.35 / $293.42
| Professional | | $21.81 | $204.35 | $293.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.05 / $204.05 / $422.13
| Facility | | $204.05 | $204.05 | $422.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.05 / $244.85 / $1,508.37
| Professional | | $204.05 | $244.85 | $1,508.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.53 / $138.94 / $219.99
| Facility | | $18.53 | $138.94 | $219.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.10 / $186.92 / $348.09
| Professional | | $162.10 | $186.92 | $348.09 |