- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.15 / $743.06 / $2,774.36
| Professional | | $563.15 | $743.06 | $2,774.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.96 / $844.96 / $844.96
| Facility | | $844.96 | $844.96 | $844.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.42 / $844.96 / $1,014.43
| Professional | | $468.42 | $844.96 | $1,014.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.62 / $575.60 / $1,065.29
| Facility | | $418.62 | $575.60 | $1,065.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.22 / $844.96 / $1,146.22
| Professional | | $508.22 | $844.96 | $1,146.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.79 / $886.82 / $1,018.88
| Professional | | $779.79 | $886.82 | $1,018.88 |