- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $147.91
| Professional | | $36.31 | $46.77 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $50.12 / $77.62
| Professional | | $37.15 | $50.12 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $74.13 / $104.71
| Professional | | $33.88 | $74.13 | $104.71 |
- 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
- $41.69 / $64.57 / $91.20
| Professional | | $41.69 | $64.57 | $91.20 |