- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.68 / $361.52 / $361.52
| Professional | | $267.68 | $361.52 | $361.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.50 / $240.50 / $322.58
| Facility | | $240.50 | $240.50 | $322.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.25 / $390.11 / $482.81
| Professional | | $386.25 | $390.11 | $482.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.15 / $531.03 / $1,757.61
| Facility | | $39.15 | $531.03 | $1,757.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.61 / $265.22 / $294.74
| Professional | | $132.61 | $265.22 | $294.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.82 / $43.08 / $43.08
| Facility | | $35.82 | $43.08 | $43.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.95 / $82.32 / $447.62
| Professional | | $42.95 | $82.32 | $447.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.22 / $192.25 / $369.38
| Professional | | $132.22 | $192.25 | $369.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.44 / $352.44 / $352.44
| Professional | | $352.44 | $352.44 | $352.44 |