- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.39 / $429.47 / $1,068.27
| Professional | | $294.39 | $429.47 | $1,068.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.92 / $1,055.08 / $1,227.18
| Facility | | $830.92 | $1,055.08 | $1,227.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.16 / $631.87 / $709.30
| Professional | | $396.16 | $631.87 | $709.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.60 / $852.25 / $1,307.39
| Professional | | $736.60 | $852.25 | $1,307.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.39 / $429.47 / $433.95
| Professional | | $294.39 | $429.47 | $433.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.00 / $582.38 / $1,146.15
| Professional | | $408.00 | $582.38 | $1,146.15 |