- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $213.80 / $489.78
| Professional | | $190.55 | $213.80 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $616.60
| Professional | | $354.81 | $512.86 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $323.59 / $457.09
| Professional | | $257.04 | $323.59 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,162.28 / $10,471.29
| Facility | | $2,630.27 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $380.19 / $691.83
| Professional | | $223.87 | $380.19 | $691.83 |