- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.55 / $250.80 / $487.09
| Professional | | $244.55 | $250.80 | $487.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.54 / $124.41 / $323.33
| Professional | | $105.54 | $124.41 | $323.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.32 / $431.32 / $1,262.29
| Facility | | $431.32 | $431.32 | $1,262.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.30 / $100.75 / $323.33
| Professional | | $99.30 | $100.75 | $323.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.32 / $431.32 / $1,262.29
| Facility | | $431.32 | $431.32 | $1,262.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.62 / $100.75 / $323.33
| Professional | | $99.62 | $100.75 | $323.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.65 / $658.64 / $2,368.53
| Professional | | $104.65 | $658.64 | $2,368.53 |