- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.27 / $129.85 / $176.32
| Professional | | $98.27 | $129.85 | $176.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.33 / $532.33 / $532.33
| Facility | | $532.33 | $532.33 | $532.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.76 / $290.57 / $290.57
| Professional | | $283.76 | $290.57 | $290.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.60 / $104.60 / $104.60
| Professional | | $104.60 | $104.60 | $104.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.56 / $184.56 / $184.56
| Professional | | $184.56 | $184.56 | $184.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.27 / $129.85 / $176.32
| Professional | | $98.27 | $129.85 | $176.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.28 / $112.91 / $259.68
| Professional | | $75.28 | $112.91 | $259.68 |