- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.37 / $676.62 / $736.50
| Professional | | $487.37 | $676.62 | $736.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.36 / $1,114.36 / $1,427.16
| Facility | | $1,114.36 | $1,114.36 | $1,427.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $921.14 / $921.14 / $2,269.09
| Professional | | $921.14 | $921.14 | $2,269.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.71 / $971.48 / $1,386.62
| Professional | | $626.71 | $971.48 | $1,386.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.23 / $933.09 / $1,386.62
| Professional | | $750.23 | $933.09 | $1,386.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.36 / $870.91 / $2,531.80
| Professional | | $754.36 | $870.91 | $2,531.80 |