- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $234.42 / $281.84
| Professional | | $194.98 | $234.42 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,174.90 / $1,548.82
| Facility | | $724.44 | $1,174.90 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $64.57 / $275.42
| Professional | | $45.71 | $64.57 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,570.40 / $5,888.44
| Facility | | $1,584.89 | $2,570.40 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $72.44 / $269.15
| Professional | | $50.12 | $72.44 | $269.15 |