- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $676.08 / $1,479.11
| Professional | | $524.81 | $676.08 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,148.15
| Facility | | $891.25 | $891.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $2,290.87
| Professional | | $912.01 | $912.01 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $831.76 / $1,258.93
| Professional | | $562.34 | $831.76 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $851.14 / $1,047.13
| Professional | | $645.65 | $851.14 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $794.33 / $1,479.11
| Professional | | $691.83 | $794.33 | $1,479.11 |