- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $64.57 / $173.78
| Professional | | $63.10 | $64.57 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $169.82 / $204.17
| Professional | | $134.90 | $169.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $114.82 / $165.96
| Professional | | $91.20 | $114.82 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,630.27 / $10,471.29
| Facility | | $1,737.80 | $2,630.27 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $131.83 / $239.88
| Professional | | $83.18 | $131.83 | $239.88 |