- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.37 / $447.45 / $1,414.37
| Professional | | $436.37 | $447.45 | $1,414.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,985.67 / $1,985.67 / $3,732.83
| Facility | | $1,985.67 | $1,985.67 | $3,732.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.43 / $373.07 / $1,186.70
| Professional | | $353.43 | $373.07 | $1,186.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,985.67 / $1,985.67 / $3,732.83
| Facility | | $1,985.67 | $1,985.67 | $3,732.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.35 / $373.07 / $1,186.70
| Professional | | $357.35 | $373.07 | $1,186.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.20 / $2,189.92 / $6,386.48
| Professional | | $370.20 | $2,189.92 | $6,386.48 |