- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.25 / $86.91 / $87.64
| Professional | | $63.25 | $86.91 | $87.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.03 / $479.23 / $532.48
| Facility | | $343.03 | $479.23 | $532.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.34 / $119.78 / $170.50
| Professional | | $117.34 | $119.78 | $170.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.56 / $654.17 / $1,150.01
| Facility | | $382.56 | $654.17 | $1,150.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.26 / $150.16 / $187.91
| Professional | | $81.26 | $150.16 | $187.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.41 / $101.12 / $181.71
| Professional | | $60.41 | $101.12 | $181.71 |