- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $81.28 / $177.83
| Professional | | $61.66 | $81.28 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $407.38 / $407.38
| Professional | | $229.09 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $117.49 / $173.78
| Professional | | $91.20 | $117.49 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $295.12 / $3,090.30
| Facility | | $257.04 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $144.54 / $302.00
| Professional | | $83.18 | $144.54 | $302.00 |