- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $302.00 / $676.08
| Professional | | $239.88 | $302.00 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $588.84
| Professional | | $151.36 | $151.36 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $354.81 / $645.65
| Facility | | $134.90 | $354.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $1,023.29 / $3,019.95
| Professional | | $275.42 | $1,023.29 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Professional | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $478.63
| Professional | | $208.93 | $208.93 | $478.63 |