- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $537.03 / $660.69
| Professional | | $467.74 | $537.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,584.89 / $1,621.81
| Professional | | $1,071.52 | $1,584.89 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $1,023.29
| Professional | | $812.83 | $812.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $512.86 / $660.69
| Facility | | $426.58 | $512.86 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,023.29 / $3,548.13
| Professional | | $891.25 | $1,023.29 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $870.96 / $1,096.48
| Professional | | $295.12 | $870.96 | $1,096.48 |