- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.30 / $208.08 / $335.53
| Professional | | $167.30 | $208.08 | $335.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.79 / $625.83 / $625.83
| Facility | | $199.79 | $625.83 | $625.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.00 / $921.00 / $921.00
| Professional | | $921.00 | $921.00 | $921.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.26 / $181.40 / $295.70
| Facility | | $81.26 | $181.40 | $295.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.69 / $146.60 / $185.10
| Professional | | $136.69 | $146.60 | $185.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.79 / $182.52 / $301.56
| Facility | | $107.79 | $182.52 | $301.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.08 / $203.08 / $203.08
| Professional | | $203.08 | $203.08 | $203.08 |