- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $173.78 / $416.87
| Professional | | $138.04 | $173.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $269.15 / $331.13
| Professional | | $151.36 | $269.15 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $208.93 / $1,288.25
| Facility | | $54.95 | $208.93 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $616.60
| Professional | | $154.88 | $281.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $295.12
| Professional | | $123.03 | $123.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $323.59 / $389.05
| Professional | | $5.01 | $323.59 | $389.05 |