- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $107.15 / $295.12
| Professional | | $83.18 | $107.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $112.20 / $173.78
| Professional | | $85.11 | $112.20 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $162.18 / $234.42
| Professional | | $75.86 | $162.18 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,548.13 / $7,244.36
| Facility | | $1,659.59 | $3,548.13 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $138.04 / $204.17
| Professional | | $93.33 | $138.04 | $204.17 |