- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.12 / $126.87 / $143.09
| Professional | | $112.12 | $126.87 | $143.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.58 / $233.00 / $445.92
| Professional | | $83.58 | $233.00 | $445.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.94 / $147.35 / $561.46
| Professional | | $71.94 | $147.35 | $561.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.02 / $192.51 / $484.63
| Facility | | $118.02 | $192.51 | $484.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.51 / $206.12 / $1,213.06
| Professional | | $88.51 | $206.12 | $1,213.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.51 / $147.52 / $325.02
| Professional | | $88.51 | $147.52 | $325.02 |