- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.31 / $87.26 / $114.68
| Professional | | $60.31 | $87.26 | $114.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.00 / $790.29 / $1,077.55
| Facility | | $744.00 | $790.29 | $1,077.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.02 / $149.72 / $273.25
| Professional | | $127.02 | $149.72 | $273.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.30 / $98.21 / $190.73
| Professional | | $54.30 | $98.21 | $190.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.51 / $104.47 / $190.73
| Professional | | $58.51 | $104.47 | $190.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.03 / $142.16 / $316.23
| Professional | | $103.03 | $142.16 | $316.23 |