- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.14 / $716.40 / $1,637.57
| Professional | | $651.14 | $716.40 | $1,637.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.50 / $665.07 / $913.56
| Professional | | $658.50 | $665.07 | $913.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,675.27 / $1,675.27 / $1,675.27
| Facility | | $1,675.27 | $1,675.27 | $1,675.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.70 / $819.71 / $1,492.40
| Professional | | $547.70 | $819.71 | $1,492.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.61 / $773.50 / $1,270.36
| Professional | | $599.61 | $773.50 | $1,270.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.55 / $682.38 / $1,277.33
| Professional | | $511.55 | $682.38 | $1,277.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.24 / $474.24 / $840.71
| Professional | | $474.24 | $474.24 | $840.71 |