- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.67 / $101.81 / $139.24
| Professional | | $55.67 | $101.81 | $139.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.06 / $146.06 / $300.88
| Professional | | $146.06 | $146.06 | $300.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.31 / $69.64 / $204.53
| Professional | | $32.31 | $69.64 | $204.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.80 / $128.06 / $197.36
| Facility | | $85.80 | $128.06 | $197.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.19 / $193.12 / $524.20
| Professional | | $163.19 | $193.12 | $524.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.34 / $81.89 / $272.12
| Professional | | $45.34 | $81.89 | $272.12 |