- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $114.82 / $309.03
| Professional | | $70.79 | $114.82 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $134.90 / $177.83
| Professional | | $95.50 | $134.90 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $120.23 / $194.98
| Professional | | $72.44 | $120.23 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,630.78 / $3,890.45
| Facility | | $3,235.94 | $3,630.78 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $125.89 / $218.78
| Professional | | $77.62 | $125.89 | $218.78 |