- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.79 / $80.59 / $117.87
| Professional | | $55.79 | $80.59 | $117.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.05 / $1,079.05 / $1,165.74
| Facility | | $1,079.05 | $1,079.05 | $1,165.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.67 / $123.38 / $361.21
| Professional | | $104.67 | $123.38 | $361.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.38 / $125.30 / $212.15
| Professional | | $78.38 | $125.30 | $212.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.43 / $127.88 / $185.22
| Professional | | $84.43 | $127.88 | $185.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.08 / $133.25 / $387.37
| Professional | | $131.08 | $133.25 | $387.37 |