- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $251.19 / $467.74
| Professional | | $158.49 | $251.19 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $812.83 / $1,258.93
| Professional | | $478.63 | $812.83 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $316.23 / $660.69
| Professional | | $165.96 | $316.23 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $794.33 / $3,235.94
| Facility | | $776.25 | $794.33 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $354.81 / $630.96
| Professional | | $204.17 | $354.81 | $630.96 |