- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $204.17 / $257.04
| Professional | | $181.97 | $204.17 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $309.03
| Facility | | $218.78 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $223.87
| Professional | | $158.49 | $158.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $446.68
| Professional | | $331.13 | $416.87 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $165.96 / $208.93
| Facility | | $36.31 | $165.96 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $257.04 / $891.25
| Professional | | $147.91 | $257.04 | $891.25 |