- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $72.44 / $117.49
| Professional | | $40.74 | $72.44 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $154.88 / $229.09
| Professional | | $89.13 | $154.88 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $97.72 / $151.36
| Professional | | $63.10 | $97.72 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $295.12 / $3,090.30
| Facility | | $263.03 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $141.25 / $245.47
| Professional | | $70.79 | $141.25 | $245.47 |