- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.36 / $116.20 / $141.22
| Professional | | $103.36 | $116.20 | $141.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.74 / $113.30 / $226.43
| Professional | | $38.74 | $113.30 | $226.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.96 / $71.11 / $197.40
| Professional | | $36.96 | $71.11 | $197.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.20 / $127.82 / $260.27
| Facility | | $96.20 | $127.82 | $260.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.31 / $145.28 / $882.93
| Professional | | $73.31 | $145.28 | $882.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.43 / $94.37 / $255.91
| Professional | | $68.43 | $94.37 | $255.91 |