- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.41 / $501.74 / $2,535.12
| Professional | | $434.41 | $501.74 | $2,535.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.55 / $785.55 / $785.55
| Facility | | $785.55 | $785.55 | $785.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.67 / $732.74 / $785.55
| Professional | | $436.67 | $732.74 | $785.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.95 / $787.80 / $812.76
| Facility | | $489.95 | $787.80 | $812.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.02 / $706.60 / $1,018.71
| Professional | | $471.02 | $706.60 | $1,018.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.15 / $775.68 / $1,372.71
| Professional | | $696.15 | $775.68 | $1,372.71 |