- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $128.82 / $162.18
| Professional | | $60.26 | $128.82 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $245.47 / $467.74
| Professional | | $125.89 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $147.91 / $281.84
| Professional | | $83.18 | $147.91 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,288.25 / $5,370.32
| Facility | | $1,258.93 | $1,288.25 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $194.98 / $436.52
| Professional | | $93.33 | $194.98 | $436.52 |