- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $45.71 / $524.81
| Professional | | $34.67 | $45.71 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Professional | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $831.76
| Professional | | $371.54 | $489.78 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $50.12 / $3,311.31
| Facility | | $44.67 | $50.12 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $457.09 / $630.96
| Professional | | $79.43 | $457.09 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $81.28
| Professional | | $50.12 | $60.26 | $81.28 |