- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.48 / $993.95 / $3,001.16
| Professional | | $682.48 | $993.95 | $3,001.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.28 / $1,194.66 / $1,606.75
| Professional | | $783.28 | $1,194.66 | $1,606.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $729.18 / $1,053.58 / $1,342.65
| Facility | | $729.18 | $1,053.58 | $1,342.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,218.48 / $1,329.25 / $1,476.94
| Professional | | $1,218.48 | $1,329.25 | $1,476.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,369.25
| Professional | | $32.34 | $32.34 | $1,369.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.07 / $1,141.26 / $1,352.75
| Professional | | $970.07 | $1,141.26 | $1,352.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.20 / $1,102.02 / $1,506.84
| Professional | | $836.20 | $1,102.02 | $1,506.84 |