- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.64 / $511.41 / $2,572.67
| Professional | | $493.64 | $511.41 | $2,572.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.00 / $531.74 / $607.78
| Professional | | $510.00 | $531.74 | $607.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.52 / $1,745.52 / $1,745.52
| Facility | | $1,745.52 | $1,745.52 | $1,745.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.70 / $672.14 / $1,499.12
| Professional | | $486.70 | $672.14 | $1,499.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.72 / $661.97 / $1,059.74
| Professional | | $497.72 | $661.97 | $1,059.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.77 / $586.12 / $984.83
| Professional | | $426.77 | $586.12 | $984.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.22 / $572.38 / $712.52
| Professional | | $393.22 | $572.38 | $712.52 |