- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.06 / $285.85 / $1,972.75
| Professional | | $231.06 | $285.85 | $1,972.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.57 / $177.34 / $222.17
| Professional | | $150.57 | $177.34 | $222.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.05 / $712.05 / $712.05
| Facility | | $712.05 | $712.05 | $712.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.55 / $1,509.22 / $2,457.52
| Professional | | $199.55 | $1,509.22 | $2,457.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.61 / $228.27 / $2,115.29
| Professional | | $128.61 | $228.27 | $2,115.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.06 / $285.85 / $1,888.83
| Professional | | $231.06 | $285.85 | $1,888.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.65 / $1,627.52 / $2,104.56
| Professional | | $966.65 | $1,627.52 | $2,104.56 |