- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.15 / $215.37 / $359.66
| Professional | | $141.15 | $215.37 | $359.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.05 / $160.06 / $228.89
| Facility | | $132.05 | $160.06 | $228.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.78 / $407.79 / $575.40
| Professional | | $183.78 | $407.79 | $575.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.18 / $155.00 / $155.00
| Facility | | $150.18 | $155.00 | $155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.41 / $179.12 / $209.01
| Professional | | $119.41 | $179.12 | $209.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.30 / $262.00 / $334.20
| Professional | | $229.30 | $262.00 | $334.20 |