- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.30 / $362.84 / $405.11
| Professional | | $301.30 | $362.84 | $405.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.52 / $443.25 / $554.05
| Professional | | $289.52 | $443.25 | $554.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.30 / $362.84 / $1,918.67
| Facility | | $301.30 | $362.84 | $1,918.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.75 / $374.44 / $574.10
| Professional | | $310.75 | $374.44 | $574.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.75 / $376.56 / $537.07
| Professional | | $310.75 | $376.56 | $537.07 |