- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.68 / $147.59 / $214.93
| Professional | | $109.68 | $147.59 | $214.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.02 / $178.40 / $254.86
| Professional | | $136.02 | $178.40 | $254.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.97 / $208.73 / $324.26
| Professional | | $133.97 | $208.73 | $324.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.50 / $160.38 / $282.89
| Facility | | $115.50 | $160.38 | $282.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.14 / $447.02 / $1,041.92
| Professional | | $184.14 | $447.02 | $1,041.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.06 / $210.83 / $351.23
| Professional | | $168.06 | $210.83 | $351.23 |