- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $151.36 / $263.03
| Professional | | $60.26 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $288.40 / $616.60
| Professional | | $154.88 | $288.40 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $162.18 / $338.84
| Professional | | $83.18 | $162.18 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $3,090.30
| Facility | | $295.12 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $208.93 / $478.63
| Professional | | $102.33 | $208.93 | $478.63 |