- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $134.90 / $346.74
| Professional | | $109.65 | $134.90 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $524.81
| Facility | | $331.13 | $446.68 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $117.49 / $239.88
| Professional | | $89.13 | $117.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $194.98
| Facility | | $128.82 | $128.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $194.98
| Professional | | $141.25 | $141.25 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $173.78 / $309.03
| Facility | | $147.91 | $173.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $141.25 / $186.21
| Professional | | $104.71 | $141.25 | $186.21 |