- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.48 / $133.97 / $148.88
| Professional | | $81.48 | $133.97 | $148.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.26 / $549.26 / $549.26
| Facility | | $549.26 | $549.26 | $549.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.34 / $240.98 / $240.98
| Professional | | $235.34 | $240.98 | $240.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.76 / $86.76 / $86.76
| Professional | | $86.76 | $86.76 | $86.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.45 / $190.45 / $190.45
| Professional | | $190.45 | $190.45 | $190.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.48 / $133.97 / $148.88
| Professional | | $81.48 | $133.97 | $148.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.17 / $116.51 / $267.93
| Professional | | $90.17 | $116.51 | $267.93 |