- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.50 / $157.04 / $158.94
| Professional | | $135.50 | $157.04 | $158.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.98 / $693.40 / $866.52
| Facility | | $388.98 | $693.40 | $866.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.41 / $159.31 / $244.40
| Professional | | $135.41 | $159.31 | $244.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,577.08 / $1,577.08 / $1,577.08
| Facility | | $1,577.08 | $1,577.08 | $1,577.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.01 / $189.65 / $340.59
| Professional | | $100.01 | $189.65 | $340.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.73 / $158.38 / $295.45
| Professional | | $69.73 | $158.38 | $295.45 |