- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.70 / $997.95 / $1,170.80
| Professional | | $939.70 | $997.95 | $1,170.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.74 / $1,758.90 / $1,986.10
| Facility | | $21.74 | $1,758.90 | $1,986.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.21 / $985.21 / $1,684.93
| Professional | | $985.21 | $985.21 | $1,684.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.55 / $1,330.86 / $2,082.81
| Professional | | $915.55 | $1,330.86 | $2,082.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.81 / $1,113.72 / $1,890.04
| Professional | | $982.81 | $1,113.72 | $1,890.04 |