- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.17 / $237.51 / $237.51
| Professional | | $126.17 | $237.51 | $237.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.40 / $329.40 / $329.40
| Professional | | $329.40 | $329.40 | $329.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.52 / $209.52 / $290.14
| Facility | | $209.52 | $209.52 | $290.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.65 / $209.52 / $320.26
| Professional | | $31.65 | $209.52 | $320.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.09 / $985.54 / $1,249.14
| Professional | | $351.09 | $985.54 | $1,249.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.91 / $214.80 / $246.34
| Professional | | $142.91 | $214.80 | $246.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.15 / $374.66 / $476.84
| Professional | | $338.15 | $374.66 | $476.84 |