- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.34 / $109.12 / $151.22
| Professional | | $75.34 | $109.12 | $151.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.86 / $677.86 / $868.15
| Facility | | $677.86 | $677.86 | $868.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.14 / $220.60 / $382.54
| Professional | | $187.14 | $220.60 | $382.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.58 / $159.37 / $230.45
| Professional | | $105.58 | $159.37 | $230.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.58 / $171.66 / $230.45
| Professional | | $124.58 | $171.66 | $230.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.38 / $152.81 / $420.79
| Professional | | $142.38 | $152.81 | $420.79 |