- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.80 / $420.63 / $532.65
| Professional | | $332.80 | $420.63 | $532.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.00 / $140.00 / $140.00
| Professional | | $140.00 | $140.00 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.30 / $150.30 / $270.50
| Professional | | $150.30 | $150.30 | $270.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.74 / $228.74 / $658.49
| Facility | | $228.74 | $228.74 | $658.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.00 / $602.00 / $693.25
| Professional | | $602.00 | $602.00 | $693.25 |