- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.76 / $102.30 / $103.49
| Professional | | $74.76 | $102.30 | $103.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.03 / $505.74 / $541.04
| Facility | | $343.03 | $505.74 | $541.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.96 / $141.96 / $206.71
| Professional | | $141.96 | $141.96 | $206.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.45 / $654.17 / $1,150.01
| Facility | | $479.45 | $654.17 | $1,150.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.65 / $183.22 / $229.39
| Professional | | $98.65 | $183.22 | $229.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.21 / $123.43 / $190.75
| Professional | | $85.21 | $123.43 | $190.75 |