- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.73 / $575.22 / $857.03
| Professional | | $528.73 | $575.22 | $857.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.19 / $982.19 / $982.19
| Facility | | $982.19 | $982.19 | $982.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.24 / $982.19 / $1,046.44
| Professional | | $528.24 | $982.19 | $1,046.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.63 / $669.12 / $982.19
| Facility | | $486.63 | $669.12 | $982.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.33 / $982.19 / $1,281.70
| Professional | | $592.33 | $982.19 | $1,281.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.12 / $996.23 / $1,127.52
| Professional | | $836.12 | $996.23 | $1,127.52 |