- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $363.08 / $630.96
| Professional | | $331.13 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,174.90 / $1,412.54
| Professional | | $724.44 | $1,174.90 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $707.95 / $891.25
| Professional | | $446.68 | $707.95 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $3,090.30
| Facility | | $295.12 | $295.12 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $660.69 / $1,380.38
| Professional | | $426.58 | $660.69 | $1,380.38 |