- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.40 / $194.76 / $236.54
| Professional | | $161.40 | $194.76 | $236.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.14 / $551.30 / $819.51
| Facility | | $472.14 | $551.30 | $819.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.88 / $224.57 / $268.52
| Professional | | $190.88 | $224.57 | $268.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.95 / $214.95 / $230.70
| Facility | | $214.95 | $214.95 | $230.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.91 / $214.95 / $214.95
| Professional | | $156.91 | $214.95 | $214.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.12 / $198.97 / $331.62
| Professional | | $137.12 | $198.97 | $331.62 |