- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.17 / $469.86 / $1,129.36
| Professional | | $315.17 | $469.86 | $1,129.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.98 / $320.57 / $366.41
| Professional | | $309.98 | $320.57 | $366.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.87 / $1,621.87 / $1,621.87
| Facility | | $1,621.87 | $1,621.87 | $1,621.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.06 / $517.29 / $1,078.36
| Professional | | $330.06 | $517.29 | $1,078.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.49 / $614.66 / $1,087.13
| Professional | | $476.49 | $614.66 | $1,087.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.10 / $570.91 / $976.40
| Professional | | $381.10 | $570.91 | $976.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.89 / $547.96 / $670.61
| Professional | | $368.89 | $547.96 | $670.61 |