- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.61 / $224.77 / $270.63
| Professional | | $187.61 | $224.77 | $270.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.03 / $139.53 / $188.34
| Facility | | $75.03 | $139.53 | $188.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.00 / $39.00 / $70.00
| Professional | | $32.00 | $39.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.00 / $136.00 / $146.30
| Professional | | $136.00 | $136.00 | $146.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.50 / $182.67 / $281.98
| Facility | | $128.50 | $182.67 | $281.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.00 / $791.00 / $791.00
| Professional | | $791.00 | $791.00 | $791.00 |