- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $107.15 / $138.04
| Professional | | $85.11 | $107.15 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $812.83 / $1,348.96
| Facility | | $194.98 | $812.83 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $371.54
| Professional | | $131.83 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $204.17 / $323.59
| Professional | | $120.23 | $204.17 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $186.21 / $588.84
| Professional | | $128.82 | $186.21 | $588.84 |