- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.84 / $289.63 / $296.92
| Professional | | $243.84 | $289.63 | $296.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.69 / $343.05 / $413.68
| Professional | | $302.69 | $343.05 | $413.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.63 / $361.58 / $381.92
| Facility | | $289.63 | $361.58 | $381.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $3,500.00 / $3,900.00
| Professional | | $30.00 | $3,500.00 | $3,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.38 / $322.38 / $336.55
| Professional | | $322.38 | $322.38 | $336.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.51 / $349.20 / $465.59
| Professional | | $220.51 | $349.20 | $465.59 |