- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $70.79 / $109.65
| Professional | | $38.02 | $70.79 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $123.03 / $186.21
| Professional | | $81.28 | $123.03 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $93.33 / $141.25
| Professional | | $56.23 | $93.33 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $295.12 / $3,090.30
| Facility | | $134.90 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $125.89 / $223.87
| Professional | | $64.57 | $125.89 | $223.87 |