- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.54 / $986.91 / $1,581.74
| Professional | | $686.54 | $986.91 | $1,581.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $748.08 / $846.26 / $1,099.96
| Professional | | $748.08 | $846.26 | $1,099.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.95 / $1,232.30 / $1,232.30
| Professional | | $124.95 | $1,232.30 | $1,232.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.16 / $686.54 / $7,933.12
| Facility | | $90.16 | $686.54 | $7,933.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.02 / $743.08 / $1,466.60
| Professional | | $496.02 | $743.08 | $1,466.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.02 / $743.08 / $1,433.95
| Professional | | $496.02 | $743.08 | $1,433.95 |