- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.95 / $122.44 / $576.57
| Professional | | $106.95 | $122.44 | $576.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.73 / $222.28 / $425.42
| Professional | | $79.73 | $222.28 | $425.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.73 / $149.12 / $428.62
| Professional | | $68.73 | $149.12 | $428.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.58 / $183.66 / $462.33
| Facility | | $112.58 | $183.66 | $462.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.44 / $196.63 / $1,157.24
| Professional | | $84.44 | $196.63 | $1,157.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.44 / $140.72 / $318.93
| Professional | | $84.44 | $140.72 | $318.93 |