- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.73 / $145.79 / $206.40
| Professional | | $112.73 | $145.79 | $206.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.47 / $276.07 / $276.07
| Professional | | $189.47 | $276.07 | $276.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.62 / $242.84 / $565.00
| Professional | | $143.62 | $242.84 | $565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.70 / $163.83 / $316.55
| Facility | | $42.70 | $163.83 | $316.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.18 / $207.22 / $1,210.74
| Professional | | $90.18 | $207.22 | $1,210.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.50 / $150.30 / $214.63
| Professional | | $35.50 | $150.30 | $214.63 |