- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.49 / $529.44 / $3,137.58
| Professional | | $430.49 | $529.44 | $3,137.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.13 / $1,309.66 / $2,149.42
| Facility | | $948.13 | $1,309.66 | $2,149.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.53 / $1,823.94 / $5,030.56
| Professional | | $1,419.53 | $1,823.94 | $5,030.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.70 / $381.28 / $590.73
| Professional | | $275.70 | $381.28 | $590.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.16 / $380.45 / $686.32
| Professional | | $316.16 | $380.45 | $686.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.49 / $529.44 / $2,024.03
| Professional | | $430.49 | $529.44 | $2,024.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.32 / $1,042.02 / $4,171.50
| Professional | | $686.32 | $1,042.02 | $4,171.50 |