- 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
- $15.81 / $304.30 / $350.03
| Professional | | $15.81 | $304.30 | $350.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.52 / $289.52 / $289.52
| Professional | | $289.52 | $289.52 | $289.52 |
- 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
- $293.08 / $401.75 / $1,057.68
| Professional | | $293.08 | $401.75 | $1,057.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.76 / $401.75 / $692.17
| Professional | | $305.76 | $401.75 | $692.17 |