- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $831.76
| Professional | | $32.36 | $47.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $338.84 / $407.38
| Professional | | $295.12 | $338.84 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $489.78 / $676.08
| Professional | | $346.74 | $489.78 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $104.71 / $3,715.35
| Facility | | $81.28 | $104.71 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $56.23 / $1,819.70
| Professional | | $38.02 | $56.23 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $77.62
| Professional | | $36.31 | $46.77 | $77.62 |