- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.36 / $104.15 / $125.35
| Professional | | $38.36 | $104.15 | $125.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.02 / $303.73 / $450.42
| Facility | | $291.02 | $303.73 | $450.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.10 / $154.31 / $374.11
| Professional | | $127.10 | $154.31 | $374.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.20 / $107.69 / $296.72
| Professional | | $40.20 | $107.69 | $296.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.10 / $110.41 / $296.72
| Professional | | $54.10 | $110.41 | $296.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.37 / $142.65 / $414.68
| Professional | | $97.37 | $142.65 | $414.68 |