- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.59 / $230.74 / $386.23
| Professional | | $192.59 | $230.74 | $386.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.00 / $103.00 / $147.00
| Professional | | $44.00 | $103.00 | $147.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.00 / $153.30 / $260.80
| Professional | | $112.00 | $153.30 | $260.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.72 / $535.10 / $535.10
| Facility | | $284.72 | $535.10 | $535.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.54 / $549.27 / $549.27
| Professional | | $536.54 | $549.27 | $549.27 |