- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.31 / $311.70 / $398.14
| Professional | | $293.31 | $311.70 | $398.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.13 / $1,281.92 / $1,517.64
| Facility | | $949.13 | $1,281.92 | $1,517.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.69 / $438.46 / $607.07
| Professional | | $372.69 | $438.46 | $607.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.30 / $324.30 / $388.30
| Facility | | $324.30 | $324.30 | $388.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.74 / $236.74 / $236.74
| Professional | | $236.74 | $236.74 | $236.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.10 / $334.91 / $558.17
| Professional | | $235.10 | $334.91 | $558.17 |