- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $741.31
| Professional | | $32.36 | $47.86 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $288.40 / $346.74
| Professional | | $251.19 | $288.40 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $575.44
| Professional | | $302.00 | $416.87 | $575.44 |
- 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 / $1,584.89
| Professional | | $38.02 | $56.23 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $77.62
| Professional | | $36.31 | $46.77 | $77.62 |