- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $741.31
| Professional | | $30.20 | $47.86 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $38.90 / $52.48
| Facility | | $31.62 | $38.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Professional | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $630.96
| Professional | | $331.13 | $457.09 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $50.12 / $70.79
| Professional | | $43.65 | $50.12 | $70.79 |