- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.72 / $1,345.93 / $1,345.93
| Professional | | $240.72 | $1,345.93 | $1,345.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.51 / $408.17 / $618.54
| Facility | | $303.51 | $408.17 | $618.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.53 / $300.45 / $303.51
| Professional | | $83.53 | $300.45 | $303.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.76 / $355.84 / $618.54
| Facility | | $191.76 | $355.84 | $618.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.39 / $188.39 / $303.51
| Professional | | $188.39 | $188.39 | $303.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.50 / $87.91 / $209.32
| Professional | | $75.50 | $87.91 | $209.32 |