- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.82 / $335.82 / $335.82
| Professional | | $335.82 | $335.82 | $335.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.31 / $166.31 / $166.31
| Facility | | $166.31 | $166.31 | $166.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.36 / $166.31 / $171.30
| Professional | | $141.36 | $166.31 | $171.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.52 / $150.43 / $226.23
| Facility | | $107.52 | $150.43 | $226.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.80 / $231.70 / $322.30
| Professional | | $30.80 | $231.70 | $322.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.39 / $64.25 / $642.50
| Professional | | $31.39 | $64.25 | $642.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.54 / $153.43 / $223.66
| Facility | | $110.54 | $153.43 | $223.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.36 / $166.31 / $171.30
| Professional | | $141.36 | $166.31 | $171.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.96 / $302.75 / $537.91
| Professional | | $157.96 | $302.75 | $537.91 |