- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.61 / $361.13 / $1,883.04
| Professional | | $324.61 | $361.13 | $1,883.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.14 / $553.14 / $553.14
| Facility | | $553.14 | $553.14 | $553.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.56 / $553.14 / $1,026.54
| Professional | | $367.56 | $553.14 | $1,026.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.38 / $575.65 / $795.05
| Facility | | $340.38 | $575.65 | $795.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.62 / $564.00 / $939.83
| Professional | | $366.62 | $564.00 | $939.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.29 / $618.00 / $757.90
| Professional | | $525.29 | $618.00 | $757.90 |