- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $346.74 / $851.14
| Professional | | $162.18 | $346.74 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $616.60 / $977.24
| Professional | | $338.84 | $616.60 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $416.87 / $645.65
| Professional | | $251.19 | $416.87 | $645.65 |
- 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
- $281.84 / $588.84 / $1,071.52
| Professional | | $281.84 | $588.84 | $1,071.52 |