- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.73 / $312.83 / $498.45
| Professional | | $188.73 | $312.83 | $498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.42 / $38.42 / $38.42
| Professional | | $38.42 | $38.42 | $38.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.25 / $333.25 / $668.86
| Facility | | $333.25 | $333.25 | $668.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.26 / $343.25 / $581.63
| Professional | | $283.26 | $343.25 | $581.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.54 / $51.22 / $83.81
| Professional | | $43.54 | $51.22 | $83.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.05 / $460.05 / $460.05
| Professional | | $460.05 | $460.05 | $460.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.28 / $293.30 / $530.67
| Professional | | $211.28 | $293.30 | $530.67 |