- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $173.78 / $346.74
| Professional | | $162.18 | $173.78 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $177.83
| Professional | | $147.91 | $147.91 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $398.11 / $489.78
| Facility | | $354.81 | $398.11 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $398.11 / $489.78
| Professional | | $354.81 | $398.11 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $380.19
| Facility | | $141.25 | $173.78 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $79.43 / $85.11
| Professional | | $60.26 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |