- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $245.47 / $426.58
| Professional | | $223.87 | $245.47 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $794.33 / $954.99
| Professional | | $489.78 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $467.74 / $602.56
| Professional | | $302.00 | $467.74 | $602.56 |
- 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
- $288.40 / $446.68 / $1,023.29
| Professional | | $288.40 | $446.68 | $1,023.29 |