- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $1,174.90
| Professional | | $32.36 | $47.86 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $478.63 / $575.44
| Professional | | $416.87 | $478.63 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $707.95 / $954.99
| Professional | | $501.19 | $707.95 | $954.99 |
- 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 / $2,454.71
| Professional | | $38.02 | $56.23 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $77.62
| Professional | | $36.31 | $46.77 | $77.62 |