- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.26 / $535.36 / $900.15
| Professional | | $489.26 | $535.36 | $900.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.31 / $510.31 / $617.48
| Professional | | $510.31 | $510.31 | $617.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,901.68 / $19,901.68 / $19,901.68
| Facility | | $19,901.68 | $19,901.68 | $19,901.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.64 / $488.59 / $885.51
| Professional | | $383.64 | $488.59 | $885.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.43 / $927.87 / $1,395.33
| Professional | | $719.43 | $927.87 | $1,395.33 |