- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $323.59 / $676.08
| Professional | | $151.36 | $323.59 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $467.74 / $912.01
| Professional | | $316.23 | $467.74 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $380.19 / $724.44
| Professional | | $218.78 | $380.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,737.80 / $3,235.94
| Facility | | $794.33 | $1,737.80 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $630.96 / $1,258.93
| Professional | | $257.04 | $630.96 | $1,258.93 |