- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $112.20 / $407.38
| Professional | | $89.13 | $112.20 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $363.08 / $363.08
| Professional | | $323.59 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $234.42
| Professional | | $186.21 | $186.21 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $107.15 / $186.21
| Facility | | $87.10 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $309.03 / $2,187.76
| Professional | | $288.40 | $309.03 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $288.40 / $380.19
| Professional | | $141.25 | $288.40 | $380.19 |