- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.93 / $604.64 / $636.46
| Professional | | $438.93 | $604.64 | $636.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,659.94 / $3,264.82 / $3,395.31
| Facility | | $2,659.94 | $3,264.82 | $3,395.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.33 / $651.33 / $1,852.74
| Professional | | $651.33 | $651.33 | $1,852.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.16 / $860.74 / $1,147.31
| Professional | | $557.16 | $860.74 | $1,147.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.30 / $758.92 / $1,147.31
| Professional | | $529.30 | $758.92 | $1,147.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.92 / $708.87 / $2,094.86
| Professional | | $591.92 | $708.87 | $2,094.86 |