- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.64 / $181.87 / $312.27
| Professional | | $114.64 | $181.87 | $312.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.55 / $198.51 / $248.14
| Facility | | $193.55 | $198.51 | $248.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.66 / $167.55 / $278.56
| Professional | | $125.66 | $167.55 | $278.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.27 / $237.26 / $415.60
| Professional | | $161.27 | $237.26 | $415.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.86 / $223.79 / $906.80
| Facility | | $152.86 | $223.79 | $906.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.02 / $206.91 / $321.88
| Professional | | $181.02 | $206.91 | $321.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.80 / $210.46 / $304.24
| Professional | | $181.80 | $210.46 | $304.24 |