- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.74 / $182.11 / $996.45
| Professional | | $92.74 | $182.11 | $996.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.27 / $158.27 / $158.27
| Facility | | $158.27 | $158.27 | $158.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.36 / $218.35 / $461.74
| Professional | | $102.36 | $218.35 | $461.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.30 / $201.38 / $378.24
| Facility | | $78.30 | $201.38 | $378.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.00 / $260.39 / $536.84
| Professional | | $140.00 | $260.39 | $536.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.17 / $317.81 / $599.40
| Professional | | $261.17 | $317.81 | $599.40 |