- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.69 / $195.41 / $242.40
| Professional | | $145.69 | $195.41 | $242.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.01 / $411.85 / $744.61
| Facility | | $114.01 | $411.85 | $744.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.02 / $380.02 / $517.78
| Professional | | $285.02 | $380.02 | $517.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.51 / $203.51 / $203.51
| Facility | | $203.51 | $203.51 | $203.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.56 / $148.56 / $377.63
| Professional | | $148.56 | $148.56 | $377.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.90 / $290.14 / $1,717.84
| Facility | | $104.90 | $290.14 | $1,717.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.85 / $162.47 / $250.38
| Professional | | $146.85 | $162.47 | $250.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.85 / $162.47 / $244.75
| Professional | | $146.85 | $162.47 | $244.75 |