- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.73 / $132.29 / $176.05
| Professional | | $112.73 | $132.29 | $176.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.50 / $168.21 / $221.56
| Professional | | $122.50 | $168.21 | $221.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.57 / $171.98 / $249.71
| Professional | | $121.57 | $171.98 | $249.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.05 / $153.40 / $235.96
| Facility | | $105.05 | $153.40 | $235.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.78 / $297.08 / $1,041.92
| Professional | | $143.78 | $297.08 | $1,041.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.06 / $181.26 / $346.73
| Professional | | $145.06 | $181.26 | $346.73 |