- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.87 / $232.51 / $268.27
| Professional | | $125.87 | $232.51 | $268.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.47 / $385.47 / $385.47
| Professional | | $385.47 | $385.47 | $385.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.12 / $237.10 / $350.19
| Facility | | $225.12 | $237.10 | $350.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.08 / $236.39 / $252.76
| Professional | | $173.08 | $236.39 | $252.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.12 / $237.10 / $350.19
| Facility | | $225.12 | $237.10 | $350.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.08 / $236.39 / $252.76
| Professional | | $173.08 | $236.39 | $252.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.46 / $282.23 / $550.80
| Professional | | $158.46 | $282.23 | $550.80 |