- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.09 / $826.05 / $3,104.18
| Professional | | $423.09 | $826.05 | $3,104.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.79 / $647.79 / $647.79
| Facility | | $647.79 | $647.79 | $647.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.69 / $647.79 / $973.10
| Professional | | $408.69 | $647.79 | $973.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.82 / $531.52 / $848.01
| Facility | | $320.82 | $531.52 | $848.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.25 / $755.37 / $1,139.19
| Professional | | $509.25 | $755.37 | $1,139.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.98 / $944.48 / $1,060.47
| Professional | | $724.98 | $944.48 | $1,060.47 |