- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.33 / $443.90 / $2,338.10
| Professional | | $337.33 | $443.90 | $2,338.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.39 / $420.11 / $1,168.09
| Facility | | $307.39 | $420.11 | $1,168.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.86 / $441.35 / $773.94
| Professional | | $310.86 | $441.35 | $773.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.39 / $474.36 / $822.25
| Facility | | $307.39 | $474.36 | $822.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.08 / $555.46 / $773.94
| Professional | | $392.08 | $555.46 | $773.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.00 / $516.09 / $725.07
| Professional | | $454.00 | $516.09 | $725.07 |