- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.03 / $470.92 / $2,577.21
| Professional | | $393.03 | $470.92 | $2,577.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.64 / $620.17 / $905.00
| Facility | | $520.64 | $620.17 | $905.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.03 / $749.22 / $1,012.31
| Professional | | $513.03 | $749.22 | $1,012.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.12 / $654.88 / $1,404.26
| Facility | | $409.12 | $654.88 | $1,404.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.00 / $642.19 / $976.27
| Professional | | $393.00 | $642.19 | $976.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.96 / $565.41 / $792.88
| Professional | | $373.96 | $565.41 | $792.88 |