- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.68 / $101.83 / $128.69
| Professional | | $96.68 | $101.83 | $128.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.42 / $112.39 / $208.17
| Professional | | $76.42 | $112.39 | $208.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.92 / $36.25 / $208.45
| Facility | | $33.92 | $36.25 | $208.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.11 / $85.11 / $226.20
| Professional | | $40.11 | $85.11 | $226.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.61 / $611.58 / $716.63
| Facility | | $276.61 | $611.58 | $716.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.93 / $882.93 / $1,123.05
| Professional | | $882.93 | $882.93 | $1,123.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.85 / $80.23 / $185.33
| Professional | | $45.85 | $80.23 | $185.33 |