- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.03 / $676.28 / $926.78
| Professional | | $430.03 | $676.28 | $926.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.04 / $2,986.96 / $3,536.21
| Facility | | $727.04 | $2,986.96 | $3,536.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.64 / $363.51 / $363.51
| Professional | | $113.64 | $363.51 | $363.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.91 / $1,981.08 / $3,482.61
| Facility | | $930.91 | $1,981.08 | $3,482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.04 / $376.71 / $555.57
| Professional | | $227.04 | $376.71 | $555.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.51 / $1,595.21 / $2,835.94
| Professional | | $240.51 | $1,595.21 | $2,835.94 |