- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.95 / $901.03 / $1,047.28
| Professional | | $408.95 | $901.03 | $1,047.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.37 / $1,147.70 / $1,597.25
| Professional | | $67.37 | $1,147.70 | $1,597.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.72 / $1,008.72 / $1,068.06
| Professional | | $1,008.72 | $1,008.72 | $1,068.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.32 / $133.35 / $687.04
| Facility | | $31.32 | $133.35 | $687.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.32 / $85.48 / $143.25
| Professional | | $31.32 | $85.48 | $143.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.40 / $1,181.64 / $1,813.67
| Professional | | $824.40 | $1,181.64 | $1,813.67 |