- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.77 / $628.62 / $1,163.54
| Professional | | $554.77 | $628.62 | $1,163.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.13 / $568.13 / $1,312.31
| Facility | | $568.13 | $568.13 | $1,312.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.96 / $508.96 / $568.13
| Professional | | $508.96 | $508.96 | $568.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.13 / $568.13 / $1,312.31
| Facility | | $568.13 | $568.13 | $1,312.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.96 / $552.16 / $720.23
| Professional | | $508.96 | $552.16 | $720.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.96 / $508.96 / $508.96
| Professional | | $508.96 | $508.96 | $508.96 |