- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $524.81
| Professional | | $32.36 | $47.86 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $190.55 / $234.42
| Professional | | $169.82 | $190.55 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Professional | | $1,148.15 | $1,148.15 | $1,148.15 |
- 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 / $1,122.02
| Professional | | $38.02 | $57.54 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $77.62
| Professional | | $36.31 | $46.77 | $77.62 |