- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.31 / $583.48 / $3,088.02
| Professional | | $444.31 | $583.48 | $3,088.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.65 / $481.96 / $1,340.07
| Facility | | $352.65 | $481.96 | $1,340.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.90 / $593.98 / $1,024.14
| Professional | | $445.90 | $593.98 | $1,024.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.65 / $686.76 / $1,080.30
| Facility | | $352.65 | $686.76 | $1,080.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.01 / $729.61 / $1,024.14
| Professional | | $515.01 | $729.61 | $1,024.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.30 / $683.90 / $1,517.00
| Professional | | $615.30 | $683.90 | $1,517.00 |