- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.38 / $242.16 / $262.27
| Professional | | $220.38 | $242.16 | $262.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.02 / $264.73 / $460.79
| Professional | | $225.02 | $264.73 | $460.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.00 / $342.74 / $456.13
| Professional | | $218.00 | $342.74 | $456.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,395.00 / $2,384.00 / $5,510.00
| Facility | | $1,395.00 | $2,384.00 | $5,510.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.24 / $312.81 / $480.88
| Professional | | $219.24 | $312.81 | $480.88 |