- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.78 / $747.59 / $3,294.52
| Professional | | $596.78 | $747.59 | $3,294.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.05 / $1,020.05 / $1,020.05
| Facility | | $1,020.05 | $1,020.05 | $1,020.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.99 / $941.35 / $1,286.71
| Professional | | $597.99 | $941.35 | $1,286.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.83 / $709.43 / $1,115.16
| Facility | | $502.83 | $709.43 | $1,115.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $706.85 / $1,056.88 / $1,631.70
| Professional | | $706.85 | $1,056.88 | $1,631.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.38 / $1,282.05 / $1,431.67
| Professional | | $1,051.38 | $1,282.05 | $1,431.67 |