- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.39 / $380.52 / $380.52
| Professional | | $276.39 | $380.52 | $380.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.86 / $16.86 / $21.07
| Facility | | $16.86 | $16.86 | $21.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.61 / $438.15 / $728.43
| Professional | | $328.61 | $438.15 | $728.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Facility | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.42 / $261.42 / $725.63
| Professional | | $261.42 | $261.42 | $725.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.08 / $350.74 / $2,352.03
| Facility | | $166.08 | $350.74 | $2,352.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.22 / $212.32 / $319.83
| Professional | | $147.22 | $212.32 | $319.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.03 / $212.32 / $304.61
| Professional | | $162.03 | $212.32 | $304.61 |