- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $125.89 / $245.47
| Professional | | $95.50 | $125.89 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $194.98 / $275.42
| Professional | | $123.03 | $194.98 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $645.65
| Facility | | $218.78 | $331.13 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $186.21 / $275.42
| Professional | | $117.49 | $186.21 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $186.21 / $309.03
| Professional | | $114.82 | $186.21 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $208.93 / $588.84
| Professional | | $109.65 | $208.93 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Facility | | $81.28 | $81.28 | $81.28 |