- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.37 / $346.48 / $574.01
| Professional | | $217.37 | $346.48 | $574.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.70 / $907.70 / $1,162.48
| Facility | | $907.70 | $907.70 | $1,162.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.04 / $465.07 / $1,335.64
| Professional | | $383.04 | $465.07 | $1,335.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.50 / $472.95 / $1,308.71
| Professional | | $297.50 | $472.95 | $1,308.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.93 / $521.54 / $1,308.71
| Professional | | $310.93 | $521.54 | $1,308.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.80 / $442.79 / $1,474.89
| Professional | | $349.80 | $442.79 | $1,474.89 |