- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $371.54
| Professional | | $181.97 | $281.84 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $933.25 / $1,445.44
| Professional | | $524.81 | $933.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $380.19 / $758.58
| Professional | | $218.78 | $380.19 | $758.58 |
- 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
- $239.88 / $416.87 / $794.33
| Professional | | $239.88 | $416.87 | $794.33 |