- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.87 / $520.52 / $2,564.30
| Professional | | $495.87 | $520.52 | $2,564.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.41 / $540.46 / $617.74
| Professional | | $540.41 | $540.46 | $617.74 |
- 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
- $473.77 / $661.44 / $1,523.69
| Professional | | $473.77 | $661.44 | $1,523.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.98 / $671.62 / $1,071.25
| Professional | | $504.98 | $671.62 | $1,071.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.07 / $626.10 / $1,161.35
| Professional | | $432.07 | $626.10 | $1,161.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.84 / $580.73 / $721.44
| Professional | | $387.84 | $580.73 | $721.44 |