- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.46 / $1,175.90 / $1,663.55
| Professional | | $981.46 | $1,175.90 | $1,663.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.66 / $690.74 / $885.61
| Facility | | $512.66 | $690.74 | $885.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.97 / $534.97 / $534.97
| Professional | | $534.97 | $534.97 | $534.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.05 / $597.92 / $702.83
| Facility | | $385.05 | $597.92 | $702.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.66 / $690.74 / $885.61
| Facility | | $512.66 | $690.74 | $885.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.97 / $534.97 / $534.97
| Professional | | $534.97 | $534.97 | $534.97 |