- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.98 / $551.37 / $2,780.13
| Professional | | $496.98 | $551.37 | $2,780.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.02 / $836.02 / $1,003.23
| Professional | | $836.02 | $836.02 | $1,003.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.02 / $836.02 / $836.02
| Facility | | $836.02 | $836.02 | $836.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.83 / $836.02 / $836.02
| Professional | | $708.83 | $836.02 | $836.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.02 / $1,036.09 / $1,078.41
| Facility | | $836.02 | $1,036.09 | $1,078.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.81 / $723.66 / $1,105.30
| Professional | | $510.81 | $723.66 | $1,105.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.93 / $974.03 / $1,473.51
| Professional | | $812.93 | $974.03 | $1,473.51 |