- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $501.19 / $630.96
| Professional | | $199.53 | $501.19 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $537.03
| Professional | | $151.36 | $151.36 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $338.84 / $616.60
| Facility | | $102.33 | $338.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $891.25 / $2,570.40
| Professional | | $234.42 | $891.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $398.11
| Professional | | $169.82 | $169.82 | $398.11 |