- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.13 / $215.66 / $235.08
| Professional | | $173.13 | $215.66 | $235.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.78 / $124.78 / $177.18
| Professional | | $124.78 | $124.78 | $177.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.57 / $377.74 / $406.80
| Facility | | $290.57 | $377.74 | $406.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.57 / $319.63 / $363.21
| Professional | | $290.57 | $319.63 | $363.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.60 / $104.60 / $298.06
| Professional | | $104.60 | $104.60 | $298.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.48 / $134.03 / $194.15
| Professional | | $72.48 | $134.03 | $194.15 |