- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $331.13 / $3,801.89
| Professional | | $275.42 | $331.13 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,071.52 / $1,288.25
| Professional | | $660.69 | $1,071.52 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $575.44 / $831.76
| Professional | | $398.11 | $575.44 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,630.27 / $10,471.29
| Facility | | $1,659.59 | $2,630.27 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $1,230.27
| Professional | | $363.08 | $588.84 | $1,230.27 |