- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.79 / $686.30 / $769.39
| Professional | | $566.79 | $686.30 | $769.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,834.11 / $2,477.17 / $2,932.69
| Facility | | $1,834.11 | $2,477.17 | $2,932.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.30 / $847.30 / $1,173.09
| Professional | | $847.30 | $847.30 | $1,173.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.02 / $714.02 / $750.35
| Facility | | $714.02 | $714.02 | $750.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.23 / $714.01 / $714.02
| Professional | | $521.23 | $714.01 | $714.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.73 / $647.16 / $1,078.61
| Professional | | $506.73 | $647.16 | $1,078.61 |