- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.22 / $316.74 / $417.03
| Professional | | $307.22 | $316.74 | $417.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $994.16 / $1,342.74 / $1,589.64
| Facility | | $994.16 | $1,342.74 | $1,589.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.53 / $395.92 / $635.87
| Professional | | $336.53 | $395.92 | $635.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.53 / $329.53 / $406.72
| Facility | | $329.53 | $329.53 | $406.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.56 / $329.53 / $329.53
| Professional | | $240.56 | $329.53 | $329.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.05 / $401.56 / $584.65
| Professional | | $317.05 | $401.56 | $584.65 |