- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.41 / $670.53 / $922.10
| Professional | | $540.41 | $670.53 | $922.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $690.97 / $690.97 / $1,366.26
| Professional | | $690.97 | $690.97 | $1,366.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.05 / $712.05 / $712.05
| Facility | | $712.05 | $712.05 | $712.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.51 / $1,137.92 / $1,745.63
| Professional | | $983.51 | $1,137.92 | $1,745.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.41 / $670.53 / $1,053.81
| Professional | | $540.41 | $670.53 | $1,053.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $747.35 / $1,080.96 / $1,397.79
| Professional | | $747.35 | $1,080.96 | $1,397.79 |