- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.72 / $282.72 / $352.39
| Professional | | $282.72 | $282.72 | $352.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.01 / $640.03 / $1,046.84
| Facility | | $174.01 | $640.03 | $1,046.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.76 / $55.68 / $69.59
| Professional | | $41.76 | $55.68 | $69.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.40 / $202.77 / $1,944.00
| Facility | | $52.40 | $202.77 | $1,944.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.25 / $111.29 / $2,708.00
| Professional | | $54.25 | $111.29 | $2,708.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.83 / $87.76 / $203.30
| Professional | | $49.83 | $87.76 | $203.30 |