- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.36 / $1,171.97 / $1,518.59
| Professional | | $730.36 | $1,171.97 | $1,518.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.65 / $995.59 / $1,036.58
| Professional | | $730.65 | $995.59 | $1,036.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.03 / $511.03 / $511.03
| Facility | | $511.03 | $511.03 | $511.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.10 / $511.03 / $526.36
| Professional | | $136.10 | $511.03 | $526.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.72 / $730.36 / $8,228.75
| Facility | | $103.72 | $730.36 | $8,228.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.49 / $771.02 / $1,521.24
| Professional | | $514.49 | $771.02 | $1,521.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.49 / $768.27 / $1,220.21
| Professional | | $514.49 | $768.27 | $1,220.21 |