- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $89.13 / $223.87
| Professional | | $50.12 | $89.13 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $257.04
| Professional | | $107.15 | $173.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $114.82 / $169.82
| Professional | | $79.43 | $114.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $3,090.30
| Facility | | $173.78 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $158.49 / $275.42
| Professional | | $87.10 | $158.49 | $275.42 |