- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $173.78 / $295.12
| Professional | | $120.23 | $173.78 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $537.03 / $831.76
| Professional | | $331.13 | $537.03 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $245.47 / $467.74
| Professional | | $134.90 | $245.47 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $338.84 / $3,090.30
| Facility | | $295.12 | $338.84 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $524.81
| Professional | | $147.91 | $251.19 | $524.81 |