- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.48 / $302.17 / $1,401.32
| Professional | | $273.48 | $302.17 | $1,401.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.36 / $294.08 / $425.00
| Professional | | $292.36 | $294.08 | $425.00 |
- 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
- $265.08 / $368.18 / $829.10
| Professional | | $265.08 | $368.18 | $829.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.79 / $364.14 / $583.10
| Professional | | $273.79 | $364.14 | $583.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.83 / $317.08 / $534.33
| Professional | | $232.83 | $317.08 | $534.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.34 / $314.86 / $391.32
| Professional | | $212.34 | $314.86 | $391.32 |