- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $346.74 / $478.63
| Professional | | $257.04 | $346.74 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,122.02 / $1,659.59
| Professional | | $724.44 | $1,122.02 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $489.78 / $977.24
| Professional | | $281.84 | $489.78 | $977.24 |
- 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
- $331.13 / $524.81 / $1,047.13
| Professional | | $331.13 | $524.81 | $1,047.13 |