- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.36 / $312.08 / $388.44
| Professional | | $243.36 | $312.08 | $388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.21 / $65.42 / $125.92
| Facility | | $20.21 | $65.42 | $125.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.33 / $558.75 / $698.44
| Professional | | $34.33 | $558.75 | $698.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.82 / $265.14 / $418.88
| Facility | | $87.82 | $265.14 | $418.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.17 / $30.98 / $51.63
| Professional | | $23.17 | $30.98 | $51.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $28.14 / $51.63
| Professional | | $17.89 | $28.14 | $51.63 |