- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.73 / $446.05 / $1,347.06
| Professional | | $326.73 | $446.05 | $1,347.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.13 / $512.13 / $512.13
| Facility | | $512.13 | $512.13 | $512.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.83 / $512.13 / $1,029.08
| Professional | | $354.83 | $512.13 | $1,029.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.61 / $511.26 / $845.02
| Facility | | $334.61 | $511.26 | $845.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.37 / $713.30 / $1,156.48
| Professional | | $431.37 | $713.30 | $1,156.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.41 / $756.39 / $995.03
| Professional | | $610.41 | $756.39 | $995.03 |