- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $776.25 / $1,023.29
| Professional | | $630.96 | $776.25 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Professional | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Professional | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $562.34 / $1,202.26
| Professional | | $489.78 | $562.34 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $416.87 / $831.76
| Facility | | $54.95 | $416.87 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $562.34 / $1,122.02
| Professional | | $489.78 | $562.34 | $1,122.02 |