- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.66 / $495.68 / $532.13
| Professional | | $378.66 | $495.68 | $532.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,225.33 / $1,655.00 / $1,959.32
| Facility | | $1,225.33 | $1,655.00 | $1,959.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.13 / $455.45 / $761.72
| Professional | | $387.13 | $455.45 | $761.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.29 / $695.50 / $695.50
| Facility | | $501.29 | $695.50 | $695.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.72 / $695.50 / $695.50
| Professional | | $507.72 | $695.50 | $695.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.99 / $522.41 / $720.62
| Professional | | $406.99 | $522.41 | $720.62 |