- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.44 / $887.64 / $3,126.54
| Professional | | $506.44 | $887.64 | $3,126.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.20 / $758.20 / $758.20
| Facility | | $758.20 | $758.20 | $758.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.49 / $682.38 / $947.89
| Professional | | $419.49 | $682.38 | $947.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.72 / $497.87 / $758.20
| Facility | | $373.72 | $497.87 | $758.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.23 / $819.90 / $1,223.75
| Professional | | $508.23 | $819.90 | $1,223.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.67 / $953.51 / $1,052.15
| Professional | | $772.67 | $953.51 | $1,052.15 |