- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.37 / $299.42 / $308.36
| Professional | | $220.37 | $299.42 | $308.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.83 / $312.83 / $375.58
| Professional | | $312.83 | $312.83 | $375.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.77 / $172.77 / $172.77
| Facility | | $172.77 | $172.77 | $172.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.07 / $172.77 / $592.50
| Professional | | $36.07 | $172.77 | $592.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.04 / $51.04 / $51.04
| Professional | | $51.04 | $51.04 | $51.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.65 / $214.81 / $358.01
| Professional | | $146.65 | $214.81 | $358.01 |