- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.26 / $534.38 / $586.13
| Professional | | $476.26 | $534.38 | $586.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.01 / $1,043.01 / $1,335.79
| Facility | | $1,043.01 | $1,043.01 | $1,335.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $625.72 / $737.58 / $1,742.02
| Professional | | $625.72 | $737.58 | $1,742.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.95 / $731.92 / $1,054.33
| Professional | | $471.95 | $731.92 | $1,054.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.01 / $706.40 / $1,054.33
| Professional | | $569.01 | $706.40 | $1,054.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.64 / $662.21 / $1,925.10
| Professional | | $581.64 | $662.21 | $1,925.10 |