- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.81 / $210.34 / $224.92
| Professional | | $192.81 | $210.34 | $224.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.77 / $130.77 / $149.47
| Professional | | $130.77 | $130.77 | $149.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,520.14 / $1,520.14 / $1,520.14
| Facility | | $1,520.14 | $1,520.14 | $1,520.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.19 / $338.78 / $452.02
| Professional | | $265.19 | $338.78 | $452.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.56 / $265.64 / $500.85
| Professional | | $183.56 | $265.64 | $500.85 |