- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $245.47 / $363.08
| Professional | | $234.42 | $245.47 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $257.04
| Facility | | $194.98 | $194.98 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $257.04
| Professional | | $165.96 | $194.98 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $19.95 / $158.49
| Facility | | $15.85 | $19.95 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $43.65 / $199.53
| Professional | | $17.78 | $43.65 | $199.53 |