- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.47 / $156.75 / $189.32
| Professional | | $139.47 | $156.75 | $189.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.32 / $609.57 / $721.65
| Facility | | $451.32 | $609.57 | $721.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.59 / $167.75 / $280.56
| Professional | | $142.59 | $167.75 | $280.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.64 / $225.10 / $225.10
| Facility | | $184.64 | $225.10 | $225.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.32 / $225.10 / $225.10
| Professional | | $164.32 | $225.10 | $225.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.06 / $172.06 / $172.06
| Facility | | $172.06 | $172.06 | $172.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.93 / $179.50 / $265.42
| Professional | | $143.93 | $179.50 | $265.42 |