- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.25 / $304.14 / $427.95
| Professional | | $275.25 | $304.14 | $427.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.61 / $222.78 / $371.54
| Facility | | $36.61 | $222.78 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.74 / $41.18 / $689.14
| Professional | | $29.74 | $41.18 | $689.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $1,260.54
| Facility | | $330.77 | $330.77 | $1,260.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.97 / $330.77 / $468.96
| Professional | | $35.97 | $330.77 | $468.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.43 / $57.43 / $57.43
| Professional | | $57.43 | $57.43 | $57.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.15 / $305.97 / $698.51
| Professional | | $214.15 | $305.97 | $698.51 |