- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $457.09 / $954.99
| Professional | | $64.57 | $457.09 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $331.13 / $2,290.87
| Professional | | $177.83 | $331.13 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $295.12 / $1,288.25
| Professional | | $72.44 | $295.12 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,621.81 / $5,370.32
| Facility | | $1,288.25 | $1,621.81 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $537.03 / $1,380.38
| Professional | | $87.10 | $537.03 | $1,380.38 |