- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.87 / $579.48 / $724.35
| Professional | | $337.87 | $579.48 | $724.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.70 / $768.75 / $1,542.19
| Professional | | $75.70 | $768.75 | $1,542.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.52 / $423.58 / $4,948.92
| Facility | | $75.52 | $423.58 | $4,948.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.50 / $463.77 / $734.05
| Professional | | $309.50 | $463.77 | $734.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.79 / $463.77 / $734.05
| Professional | | $341.79 | $463.77 | $734.05 |