- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.00 / $323.52 / $363.80
| Professional | | $268.00 | $323.52 | $363.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.24 / $1,171.32 / $1,386.71
| Facility | | $867.24 | $1,171.32 | $1,386.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.36 / $322.36 / $539.11
| Professional | | $322.36 | $322.36 | $539.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.82 / $393.88 / $393.88
| Facility | | $354.82 | $393.88 | $393.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.52 / $287.52 / $287.52
| Professional | | $287.52 | $287.52 | $287.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.58 / $350.30 / $510.02
| Professional | | $276.58 | $350.30 | $510.02 |