- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.90 / $132.99 / $180.21
| Professional | | $96.90 | $132.99 | $180.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.13 / $766.13 / $934.64
| Facility | | $766.13 | $766.13 | $934.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.86 / $179.54 / $548.46
| Professional | | $147.86 | $179.54 | $548.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.16 / $181.74 / $464.48
| Professional | | $132.16 | $181.74 | $464.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.91 / $190.51 / $464.48
| Professional | | $140.91 | $190.51 | $464.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.53 / $167.48 / $538.45
| Professional | | $134.53 | $167.48 | $538.45 |