- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.06 / $297.56 / $370.18
| Professional | | $228.06 | $297.56 | $370.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.04 / $328.20 / $454.70
| Professional | | $259.04 | $328.20 | $454.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.23 / $378.23 / $393.22
| Professional | | $378.23 | $378.23 | $393.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.87 / $425.93 / $771.22
| Facility | | $303.87 | $425.93 | $771.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.78 / $528.16 / $2,551.41
| Professional | | $335.78 | $528.16 | $2,551.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.57 / $454.73 / $794.95
| Professional | | $330.57 | $454.73 | $794.95 |