- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.03 / $285.94 / $438.42
| Professional | | $162.03 | $285.94 | $438.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.57 / $37.57 / $37.57
| Professional | | $37.57 | $37.57 | $37.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $550.75
| Facility | | $307.55 | $307.55 | $550.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.42 / $400.54 / $725.63
| Professional | | $261.42 | $400.54 | $725.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.08 / $50.09 / $75.14
| Professional | | $45.08 | $50.09 | $75.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.15 / $344.15 / $344.15
| Professional | | $344.15 | $344.15 | $344.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.94 / $249.79 / $428.81
| Professional | | $176.94 | $249.79 | $428.81 |