- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.38 / $190.25 / $998.60
| Professional | | $136.38 | $190.25 | $998.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.10 / $350.10 / $350.10
| Professional | | $350.10 | $350.10 | $350.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.94 / $376.43 / $376.43
| Facility | | $197.94 | $376.43 | $376.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.94 / $306.12 / $376.43
| Professional | | $197.94 | $306.12 | $376.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.62 / $358.50 / $376.43
| Facility | | $176.62 | $358.50 | $376.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.94 / $282.52 / $376.70
| Professional | | $197.94 | $282.52 | $376.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.84 / $158.03 / $180.91
| Professional | | $142.84 | $158.03 | $180.91 |