- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.75 / $607.38 / $685.06
| Professional | | $536.75 | $607.38 | $685.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.59 / $715.74 / $1,391.07
| Professional | | $60.59 | $715.74 | $1,391.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.30 / $634.99 / $1,583.77
| Facility | | $600.30 | $634.99 | $1,583.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.63 / $423.75 / $3,517.13
| Professional | | $296.63 | $423.75 | $3,517.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.63 / $423.75 / $915.30
| Professional | | $296.63 | $423.75 | $915.30 |