- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $524.81 / $1,148.15
| Professional | | $72.44 | $524.81 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Professional | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $60.26 / $77.62
| Professional | | $43.65 | $60.26 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $81.28 / $131.83
| Professional | | $48.98 | $81.28 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $1,202.26 / $1,905.46
| Professional | | $56.23 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |