- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $54.95 / $77.62
| Professional | | $50.12 | $54.95 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $223.87 / $269.15
| Professional | | $144.54 | $223.87 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $93.33 / $199.53
| Professional | | $54.95 | $93.33 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,288.25 / $5,370.32
| Facility | | $1,258.93 | $1,288.25 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $93.33 / $190.55
| Professional | | $60.26 | $93.33 | $190.55 |