- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $107.15 / $154.88
| Professional | | $87.10 | $107.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $120.23 / $141.25
| Professional | | $83.18 | $120.23 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $125.89 / $181.97
| Professional | | $95.50 | $125.89 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,778.28 / $5,370.32
| Facility | | $660.69 | $1,778.28 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $104.71 / $165.96
| Professional | | $77.62 | $104.71 | $165.96 |