- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $549.54 / $1,348.96
| Professional | | $478.63 | $549.54 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,412.54 / $1,698.24
| Professional | | $977.24 | $1,412.54 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $891.25 / $1,230.27
| Professional | | $724.44 | $891.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,365.16 / $14,125.38
| Facility | | $4,168.69 | $4,365.16 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,047.13 / $1,995.26
| Professional | | $645.65 | $1,047.13 | $1,995.26 |