- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.27 / $356.15 / $497.74
| Professional | | $42.27 | $356.15 | $497.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $47.12 / $70.78
| Professional | | $33.11 | $47.12 | $70.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.21 / $810.29 / $1,252.31
| Facility | | $134.21 | $810.29 | $1,252.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,919.21 / $3,919.21 / $3,919.21
| Professional | | $3,919.21 | $3,919.21 | $3,919.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.97 / $49.37 / $81.20
| Professional | | $38.97 | $49.37 | $81.20 |