- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $239.88 / $269.15
| Professional | | $158.49 | $239.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Professional | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $234.42 / $295.12
| Facility | | $186.21 | $234.42 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $234.42 / $295.12
| Professional | | $186.21 | $234.42 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $323.59
| Facility | | $151.36 | $245.47 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $117.49
| Professional | | $100.00 | $100.00 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $120.23 / $169.82
| Professional | | $107.15 | $120.23 | $169.82 |