- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.91 / $519.35 / $2,387.11
| Professional | | $441.91 | $519.35 | $2,387.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.00 / $503.07 / $575.02
| Professional | | $490.00 | $503.07 | $575.02 |
- 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
- $459.07 / $620.30 / $1,418.30
| Professional | | $459.07 | $620.30 | $1,418.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.34 / $622.89 / $997.66
| Professional | | $468.34 | $622.89 | $997.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.48 / $541.01 / $909.35
| Professional | | $402.48 | $541.01 | $909.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.41 / $538.59 / $669.47
| Professional | | $360.41 | $538.59 | $669.47 |