- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.86 / $75.92 / $135.75
| Professional | | $41.86 | $75.92 | $135.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.43 / $412.17 / $457.84
| Facility | | $377.43 | $412.17 | $457.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.57 / $148.82 / $427.19
| Professional | | $122.57 | $148.82 | $427.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.92 / $124.32 / $334.07
| Professional | | $57.92 | $124.32 | $334.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.56 / $136.41 / $334.07
| Professional | | $77.56 | $136.41 | $334.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.40 / $129.41 / $458.03
| Professional | | $113.40 | $129.41 | $458.03 |