- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $50.12 / $851.14
| Professional | | $33.11 | $50.12 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $239.88 / $288.40
| Professional | | $208.93 | $239.88 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $478.63
| Professional | | $251.19 | $346.74 | $478.63 |
- 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 / $56.23 / $1,348.96
| Professional | | $38.02 | $56.23 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $77.62
| Professional | | $36.31 | $46.77 | $77.62 |