- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.14 / $451.94 / $2,402.75
| Professional | | $324.14 | $451.94 | $2,402.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.77 / $718.77 / $718.77
| Facility | | $718.77 | $718.77 | $718.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.01 / $645.52 / $1,125.86
| Professional | | $414.01 | $645.52 | $1,125.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.21 / $597.10 / $718.77
| Facility | | $349.21 | $597.10 | $718.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.93 / $734.93 / $1,224.66
| Professional | | $440.93 | $734.93 | $1,224.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.17 / $704.60 / $921.72
| Professional | | $600.17 | $704.60 | $921.72 |