- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.23 / $159.31 / $365.37
| Professional | | $94.23 | $159.31 | $365.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.31 / $126.08 / $188.44
| Professional | | $106.31 | $126.08 | $188.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.64 / $531.64 / $531.64
| Facility | | $531.64 | $531.64 | $531.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.08 / $210.26 / $498.66
| Professional | | $149.08 | $210.26 | $498.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.36 / $213.63 / $450.24
| Professional | | $120.36 | $213.63 | $450.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.67 / $159.31 / $365.37
| Professional | | $85.67 | $159.31 | $365.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.74 / $303.66 / $464.14
| Professional | | $188.74 | $303.66 | $464.14 |