- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $288.40 / $426.58
| Professional | | $223.87 | $288.40 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $977.24 / $1,412.54
| Professional | | $630.96 | $977.24 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $416.87 / $851.14
| Professional | | $245.47 | $416.87 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,344.23 / $5,370.32
| Facility | | $1,288.25 | $2,344.23 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $446.68 / $891.25
| Professional | | $281.84 | $446.68 | $891.25 |