- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.58 / $682.20 / $893.47
| Professional | | $474.58 | $682.20 | $893.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.53 / $773.30 / $971.55
| Professional | | $628.53 | $773.30 | $971.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,355.54 / $2,355.54 / $2,355.54
| Facility | | $2,355.54 | $2,355.54 | $2,355.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.09 / $2,355.54 / $2,426.21
| Professional | | $77.09 | $2,355.54 | $2,426.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.67 / $502.59 / $4,660.41
| Facility | | $64.67 | $502.59 | $4,660.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.04 / $473.62 / $861.78
| Professional | | $332.04 | $473.62 | $861.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.33 / $435.23 / $842.60
| Professional | | $364.33 | $435.23 | $842.60 |