- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.65 / $627.29 / $3,266.33
| Professional | | $575.65 | $627.29 | $3,266.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.82 / $984.82 / $984.82
| Facility | | $984.82 | $984.82 | $984.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.42 / $876.53 / $1,741.44
| Professional | | $609.42 | $876.53 | $1,741.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.59 / $872.10 / $1,186.57
| Facility | | $605.59 | $872.10 | $1,186.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.11 / $984.82 / $1,628.08
| Professional | | $635.11 | $984.82 | $1,628.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.79 / $1,028.92 / $1,241.80
| Professional | | $856.79 | $1,028.92 | $1,241.80 |