- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.10 / $162.15 / $1,092.46
| Professional | | $90.10 | $162.15 | $1,092.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.64 / $288.64 / $294.32
| Facility | | $288.64 | $288.64 | $294.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.38 / $284.38 / $309.30
| Facility | | $284.38 | $284.38 | $309.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.29 / $194.60 / $381.92
| Professional | | $177.29 | $194.60 | $381.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.38 / $284.38 / $309.30
| Facility | | $284.38 | $284.38 | $309.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $194.60 / $381.92
| Professional | | $50.00 | $194.60 | $381.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.20 / $129.03 / $764.55
| Professional | | $74.20 | $129.03 | $764.55 |