- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.21 / $151.33 / $310.44
| Professional | | $121.21 | $151.33 | $310.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.43 / $127.75 / $339.47
| Professional | | $83.43 | $127.75 | $339.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.42 / $217.94 / $360.72
| Facility | | $210.42 | $217.94 | $360.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.15 / $237.75 / $444.74
| Professional | | $75.15 | $237.75 | $444.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.27 / $210.42 / $1,172.20
| Professional | | $135.27 | $210.42 | $1,172.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.30 / $187.88 / $268.29
| Professional | | $150.30 | $187.88 | $268.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.18 / $187.71 / $391.71
| Professional | | $90.18 | $187.71 | $391.71 |