- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.38 / $86.49 / $237.82
| Professional | | $61.38 | $86.49 | $237.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.84 / $387.15 / $1,177.25
| Facility | | $351.84 | $387.15 | $1,177.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.72 / $575.02 / $866.65
| Professional | | $533.72 | $575.02 | $866.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.62 / $228.13 / $499.07
| Professional | | $107.62 | $228.13 | $499.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.62 / $260.52 / $543.96
| Professional | | $107.62 | $260.52 | $543.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.69 / $313.45 / $1,063.71
| Professional | | $249.69 | $313.45 | $1,063.71 |