- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.74 / $228.22 / $268.08
| Professional | | $180.74 | $228.22 | $268.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,111.54 / $7,111.54 / $7,682.94
| Facility | | $7,111.54 | $7,111.54 | $7,682.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.72 / $495.72 / $716.91
| Professional | | $495.72 | $495.72 | $716.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.35 / $287.45 / $460.56
| Professional | | $241.35 | $287.45 | $460.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.88 / $289.35 / $460.56
| Professional | | $216.88 | $289.35 | $460.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.14 / $292.23 / $840.92
| Professional | | $266.14 | $292.23 | $840.92 |