- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $416.87
| Professional | | $32.36 | $47.86 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $144.54 / $173.78
| Professional | | $125.89 | $144.54 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $208.93 / $288.40
| Professional | | $151.36 | $208.93 | $288.40 |
- 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 / $891.25
| Professional | | $38.02 | $56.23 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $77.62
| Professional | | $36.31 | $46.77 | $77.62 |