- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.35 / $415.24 / $528.00
| Professional | | $319.35 | $415.24 | $528.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $396.27
| Facility | | $330.77 | $330.77 | $396.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.14 / $330.77 / $506.25
| Professional | | $281.14 | $330.77 | $506.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.10 / $872.10 / $872.10
| Professional | | $872.10 | $872.10 | $872.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.92 / $383.92 / $383.92
| Professional | | $383.92 | $383.92 | $383.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.82 / $291.12 / $396.53
| Professional | | $228.82 | $291.12 | $396.53 |