- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.39 / $278.43 / $466.07
| Professional | | $232.39 | $278.43 | $466.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.00 / $133.00 / $177.00
| Professional | | $44.00 | $133.00 | $177.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.40 / $167.40 / $314.20
| Professional | | $125.40 | $167.40 | $314.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.06 / $593.50 / $593.50
| Facility | | $335.06 | $593.50 | $593.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $639.41 / $665.33 / $665.33
| Professional | | $639.41 | $665.33 | $665.33 |