- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.63 / $217.20 / $271.50
| Professional | | $177.63 | $217.20 | $271.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.34 / $139.57 / $204.16
| Facility | | $107.34 | $139.57 | $204.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $405.69 / $405.69 / $405.69
| Professional | | $405.69 | $405.69 | $405.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.00 / $140.00 / $140.00
| Facility | | $140.00 | $140.00 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.24 / $123.00 / $196.42
| Professional | | $99.24 | $123.00 | $196.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.33 / $104.36 / $125.23
| Professional | | $80.33 | $104.36 | $125.23 |