- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.15 / $321.12 / $495.30
| Professional | | $145.15 | $321.12 | $495.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.00 / $600.00 / $1,111.00
| Professional | | $311.00 | $600.00 | $1,111.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.19 / $397.57 / $756.91
| Professional | | $224.19 | $397.57 | $756.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.28 / $673.92 / $1,091.33
| Professional | | $404.28 | $673.92 | $1,091.33 |