- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.47 / $505.80 / $2,476.55
| Professional | | $480.47 | $505.80 | $2,476.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.73 / $517.05 / $600.00
| Professional | | $500.73 | $517.05 | $600.00 |
- 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
- $449.64 / $627.67 / $1,480.72
| Professional | | $449.64 | $627.67 | $1,480.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.57 / $649.79 / $1,040.10
| Professional | | $488.57 | $649.79 | $1,040.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.81 / $535.27 / $942.39
| Professional | | $403.81 | $535.27 | $942.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.49 / $561.86 / $698.09
| Professional | | $374.49 | $561.86 | $698.09 |