- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.22 / $755.88 / $1,260.63
| Professional | | $671.22 | $755.88 | $1,260.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.55 / $1,258.55 / $1,510.25
| Professional | | $1,258.55 | $1,258.55 | $1,510.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.55 / $1,591.49 / $2,877.36
| Facility | | $440.55 | $1,591.49 | $2,877.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,101.38 / $1,468.50 / $1,927.41
| Professional | | $1,101.38 | $1,468.50 | $1,927.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.60 / $840.60 / $840.60
| Facility | | $840.60 | $840.60 | $840.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.64 / $613.64 / $1,634.25
| Professional | | $613.64 | $613.64 | $1,634.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.35 / $1,065.59 / $6,648.31
| Facility | | $405.35 | $1,065.59 | $6,648.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.80 / $627.88 / $945.81
| Professional | | $541.80 | $627.88 | $945.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.80 / $627.88 / $945.81
| Professional | | $541.80 | $627.88 | $945.81 |