- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.18 / $202.07 / $229.19
| Professional | | $114.18 | $202.07 | $229.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.05 / $243.24 / $628.47
| Facility | | $215.05 | $243.24 | $628.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.70 / $127.25 / $127.25
| Professional | | $111.70 | $127.25 | $127.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.03 / $326.44 / $573.86
| Facility | | $189.03 | $326.44 | $573.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.38 / $138.21 / $197.23
| Professional | | $83.38 | $138.21 | $197.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.97 / $185.39 / $310.26
| Professional | | $89.97 | $185.39 | $310.26 |