- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.76 / $518.32 / $682.46
| Professional | | $502.76 | $518.32 | $682.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,626.88 / $2,197.31 / $2,601.37
| Facility | | $1,626.88 | $2,197.31 | $2,601.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.00 / $604.71 / $1,011.33
| Professional | | $514.00 | $604.71 | $1,011.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.20 / $582.20 / $665.57
| Facility | | $582.20 | $582.20 | $665.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.01 / $582.20 / $582.20
| Professional | | $425.01 | $582.20 | $582.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.48 / $647.01 / $956.76
| Professional | | $449.48 | $647.01 | $956.76 |