- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.74 / $720.36 / $1,518.59
| Professional | | $561.74 | $720.36 | $1,518.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.03 / $511.03 / $511.03
| Facility | | $511.03 | $511.03 | $511.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.38 / $511.03 / $1,807.50
| Professional | | $434.38 | $511.03 | $1,807.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.46 / $673.46 / $673.46
| Professional | | $673.46 | $673.46 | $673.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.28 / $709.28 / $1,141.35
| Professional | | $709.28 | $709.28 | $1,141.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.91 / $899.10 / $1,762.44
| Professional | | $645.91 | $899.10 | $1,762.44 |