- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.23 / $342.47 / $355.85
| Professional | | $292.23 | $342.47 | $355.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.75 / $15.81 / $17.03
| Professional | | $13.75 | $15.81 | $17.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.24 / $403.24 / $403.24
| Facility | | $403.24 | $403.24 | $403.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.52 / $289.52 / $1,690.08
| Professional | | $289.52 | $289.52 | $1,690.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Professional | | $45.00 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.14 / $327.51 / $548.66
| Professional | | $281.14 | $327.51 | $548.66 |