- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $199.53 / $316.23
| Professional | | $181.97 | $199.53 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $794.33 / $954.99
| Professional | | $512.86 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $331.13 / $588.84
| Professional | | $194.98 | $331.13 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,754.23 / $10,471.29
| Facility | | $2,630.27 | $2,754.23 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $323.59 / $645.65
| Professional | | $204.17 | $323.59 | $645.65 |