- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.49 / $134.41 / $171.71
| Professional | | $126.49 | $134.41 | $171.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.33 / $552.82 / $654.47
| Facility | | $409.33 | $552.82 | $654.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.33 / $152.15 / $254.44
| Professional | | $129.33 | $152.15 | $254.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.47 / $169.96 / $169.96
| Facility | | $167.47 | $169.96 | $169.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.07 / $124.07 / $124.07
| Professional | | $124.07 | $124.07 | $124.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.54 / $165.33 / $240.72
| Professional | | $130.54 | $165.33 | $240.72 |