- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.82 / $553.82 / $583.75
| Professional | | $553.82 | $553.82 | $583.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,268.63 / $22,395.57 / $25,253.84
| Facility | | $17,268.63 | $22,395.57 | $25,253.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.25 / $730.62 / $1,065.07
| Professional | | $608.25 | $730.62 | $1,065.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.65 / $798.35 / $1,207.58
| Professional | | $595.65 | $798.35 | $1,207.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.36 / $800.26 / $1,227.65
| Professional | | $621.36 | $800.26 | $1,227.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.82 / $553.82 / $583.75
| Professional | | $553.82 | $553.82 | $583.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.73 / $757.24 / $1,117.23
| Professional | | $534.73 | $757.24 | $1,117.23 |