- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.27 / $311.63 / $620.90
| Professional | | $42.27 | $311.63 | $620.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.82 / $790.81 / $1,065.21
| Professional | | $40.82 | $790.81 | $1,065.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.26 / $112.39 / $420.70
| Professional | | $102.26 | $112.39 | $420.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.32 / $85.68 / $149.59
| Facility | | $31.32 | $85.68 | $149.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.32 / $76.93 / $143.25
| Professional | | $31.32 | $76.93 | $143.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.52 / $64.55 / $112.24
| Professional | | $45.52 | $64.55 | $112.24 |