- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.10 / $65.72 / $92.56
| Professional | | $60.10 | $65.72 | $92.56 |
- 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
- $82.72 / $100.80 / $160.28
| Professional | | $82.72 | $100.80 | $160.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.20 / $654.17 / $1,150.01
| Facility | | $237.20 | $654.17 | $1,150.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.31 / $115.90 / $162.94
| Professional | | $69.31 | $115.90 | $162.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.90 / $116.25 / $172.73
| Professional | | $77.90 | $116.25 | $172.73 |