- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.85 / $401.64 / $1,832.39
| Professional | | $338.85 | $401.64 | $1,832.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.84 / $388.04 / $455.00
| Professional | | $387.84 | $388.04 | $455.00 |
- 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
- $341.25 / $469.34 / $1,093.43
| Professional | | $341.25 | $469.34 | $1,093.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.04 / $481.51 / $768.20
| Professional | | $362.04 | $481.51 | $768.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.73 / $417.36 / $696.77
| Professional | | $304.73 | $417.36 | $696.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.18 / $416.35 / $517.04
| Professional | | $292.18 | $416.35 | $517.04 |