- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.71 / $937.86 / $1,139.23
| Professional | | $561.71 | $937.86 | $1,139.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.47 / $78.06 / $142.46
| Professional | | $33.47 | $78.06 | $142.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.53 / $1,227.53 / $1,227.53
| Professional | | $1,227.53 | $1,227.53 | $1,227.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.66 / $937.86 / $1,615.12
| Facility | | $548.66 | $937.86 | $1,615.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.84 / $177.26 / $5,878.81
| Professional | | $65.84 | $177.26 | $5,878.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.84 / $355.34 / $1,205.98
| Professional | | $65.84 | $355.34 | $1,205.98 |