- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $281.84
| Professional | | $151.36 | $234.42 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $741.31
| Professional | | $316.23 | $489.78 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $691.83
| Professional | | $223.87 | $354.81 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $794.33 / $3,235.94
| Facility | | $602.56 | $794.33 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $346.74 / $776.25
| Professional | | $190.55 | $346.74 | $776.25 |