- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $954.99
| Professional | | $32.36 | $47.86 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $380.19 / $467.74
| Professional | | $338.84 | $380.19 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $562.34 / $758.58
| Professional | | $398.11 | $562.34 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $104.71 / $3,388.44
| Facility | | $34.67 | $104.71 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $57.54 / $2,041.74
| Professional | | $38.02 | $57.54 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $77.62
| Professional | | $36.31 | $46.77 | $77.62 |