- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.12 / $388.06 / $399.65
| Professional | | $322.12 | $388.06 | $399.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.89 / $405.44 / $495.36
| Professional | | $199.89 | $405.44 | $495.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.88 / $450.88 / $450.88
| Facility | | $450.88 | $450.88 | $450.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.68 / $450.88 / $798.75
| Professional | | $53.68 | $450.88 | $798.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.51 / $71.51 / $71.51
| Professional | | $71.51 | $71.51 | $71.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.57 / $230.74 / $418.10
| Facility | | $36.57 | $230.74 | $418.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.90 / $327.66 / $546.10
| Professional | | $211.90 | $327.66 | $546.10 |