- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.98 / $168.58 / $519.76
| Professional | | $87.98 | $168.58 | $519.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.86 / $1,607.92 / $2,533.31
| Facility | | $1,530.86 | $1,607.92 | $2,533.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.08 / $294.93 / $872.03
| Professional | | $242.08 | $294.93 | $872.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.02 / $257.58 / $872.03
| Professional | | $134.02 | $257.58 | $872.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.68 / $282.73 / $872.03
| Professional | | $155.68 | $282.73 | $872.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.97 / $313.45 / $911.21
| Professional | | $214.97 | $313.45 | $911.21 |