- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.93 / $145.22 / $175.24
| Professional | | $119.93 | $145.22 | $175.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.02 / $207.90 / $249.15
| Professional | | $171.02 | $207.90 | $249.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.45 / $203.93 / $237.68
| Professional | | $167.45 | $203.93 | $237.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.91 / $207.82 / $906.80
| Facility | | $141.91 | $207.82 | $906.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.58 / $234.98 / $384.95
| Professional | | $180.58 | $234.98 | $384.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.58 / $244.48 / $334.05
| Professional | | $180.58 | $244.48 | $334.05 |