- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.82 / $634.98 / $1,832.79
| Professional | | $316.82 | $634.98 | $1,832.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $679.33 / $679.33 / $679.33
| Facility | | $679.33 | $679.33 | $679.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.23 / $611.40 / $1,291.89
| Professional | | $310.23 | $611.40 | $1,291.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.09 / $538.77 / $952.48
| Facility | | $335.09 | $538.77 | $952.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.59 / $756.33 / $1,346.10
| Professional | | $471.59 | $756.33 | $1,346.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $637.00 / $1,015.74 / $1,200.64
| Professional | | $637.00 | $1,015.74 | $1,200.64 |