- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.01 / $492.50 / $2,244.54
| Professional | | $439.01 | $492.50 | $2,244.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.25 / $476.77 / $544.35
| Professional | | $476.25 | $476.77 | $544.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.40 / $1,267.40 / $1,267.40
| Facility | | $1,267.40 | $1,267.40 | $1,267.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.01 / $604.42 / $1,373.81
| Professional | | $420.01 | $604.42 | $1,373.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.50 / $635.08 / $1,015.74
| Professional | | $477.50 | $635.08 | $1,015.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.47 / $542.25 / $1,076.59
| Professional | | $396.47 | $542.25 | $1,076.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.77 / $549.13 / $681.65
| Professional | | $362.77 | $549.13 | $681.65 |