- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.67 / $243.25 / $243.25
| Professional | | $188.67 | $243.25 | $243.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.78 / $10.78 / $13.47
| Facility | | $10.78 | $10.78 | $13.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.07 / $280.08 / $465.65
| Professional | | $210.07 | $280.08 | $465.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.43 / $244.43 / $244.43
| Facility | | $244.43 | $244.43 | $244.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.43 / $207.77 / $448.59
| Professional | | $178.43 | $207.77 | $448.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.97 / $249.57 / $1,550.44
| Facility | | $224.97 | $249.57 | $1,550.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.66 / $152.44 / $241.32
| Professional | | $120.66 | $152.44 | $241.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.72 / $152.44 / $241.32
| Professional | | $132.72 | $152.44 | $241.32 |