- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.37 / $310.48 / $310.48
| Professional | | $188.37 | $310.48 | $310.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.41 / $305.41 / $305.41
| Professional | | $305.41 | $305.41 | $305.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.52 / $209.52 / $266.50
| Facility | | $209.52 | $209.52 | $266.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.09 / $209.52 / $517.50
| Professional | | $178.09 | $209.52 | $517.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.63 / $310.48 / $372.58
| Facility | | $128.63 | $310.48 | $372.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.03 / $333.03 / $333.03
| Professional | | $333.03 | $333.03 | $333.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.58 / $210.84 / $368.60
| Professional | | $131.58 | $210.84 | $368.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.70 / $2,082.21 / $2,082.21
| Facility | | $409.70 | $2,082.21 | $2,082.21 |