- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.40 / $343.54 / $366.22
| Professional | | $58.40 | $343.54 | $366.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.63 / $344.52 / $600.14
| Professional | | $243.63 | $344.52 | $600.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $699.00
| Facility | | $60.26 | $60.26 | $699.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.71 / $216.71 / $216.71
| Professional | | $216.71 | $216.71 | $216.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.47 / $66.30 / $103.73
| Professional | | $51.47 | $66.30 | $103.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.40 / $343.54 / $366.22
| Professional | | $58.40 | $343.54 | $366.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.62 / $475.37 / $637.42
| Professional | | $91.62 | $475.37 | $637.42 |