- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $83.18 / $85.11
| Professional | | $67.61 | $83.18 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $204.17
| Professional | | $151.36 | $151.36 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $114.82 / $295.12
| Facility | | $67.61 | $114.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $131.83 / $812.83
| Professional | | $95.50 | $131.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Professional | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Professional | | $95.50 | $95.50 | $95.50 |