- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.43 / $583.91 / $642.02
| Professional | | $426.43 | $583.91 | $642.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.40 / $1,007.40 / $1,290.19
| Facility | | $1,007.40 | $1,007.40 | $1,290.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.71 / $681.71 / $1,957.74
| Professional | | $681.71 | $681.71 | $1,957.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.16 / $849.02 / $1,203.83
| Professional | | $541.16 | $849.02 | $1,203.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.67 / $816.78 / $1,203.83
| Professional | | $654.67 | $816.78 | $1,203.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.95 / $756.11 / $2,198.07
| Professional | | $653.95 | $756.11 | $2,198.07 |