- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $309.03 / $426.58
| Professional | | $218.78 | $309.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $588.84 / $851.14
| Professional | | $407.38 | $588.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $489.78 / $2,398.83
| Facility | | $208.93 | $489.78 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $138.04 / $213.80
| Professional | | $77.62 | $138.04 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $117.49 / $218.78
| Professional | | $69.18 | $117.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $478.63 / $870.96
| Professional | | $66.07 | $478.63 | $870.96 |