- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.51 / $832.80 / $3,082.87
| Professional | | $628.51 | $832.80 | $3,082.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.02 / $948.02 / $948.02
| Facility | | $948.02 | $948.02 | $948.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.11 / $948.02 / $981.25
| Professional | | $488.11 | $948.02 | $981.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.08 / $646.36 / $948.02
| Facility | | $470.08 | $646.36 | $948.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.71 / $947.91 / $1,230.59
| Professional | | $568.71 | $947.91 | $1,230.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.24 / $958.74 / $1,082.88
| Professional | | $795.24 | $958.74 | $1,082.88 |