- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $95.50 / $190.55
| Professional | | $61.66 | $95.50 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $91.20 / $165.96
| Professional | | $60.26 | $91.20 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $134.90 / $204.17
| Professional | | $81.28 | $134.90 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,412.54 / $6,456.54
| Facility | | $436.52 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $104.71 / $190.55
| Professional | | $66.07 | $104.71 | $190.55 |