- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.74 / $675.48 / $844.35
| Professional | | $501.74 | $675.48 | $844.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.41 / $638.41 / $3,087.20
| Facility | | $638.41 | $638.41 | $3,087.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.00 / $1,313.00 / $1,530.66
| Professional | | $444.00 | $1,313.00 | $1,530.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.18 / $362.18 / $536.00
| Facility | | $362.18 | $362.18 | $536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.18 / $490.00 / $611.46
| Professional | | $362.18 | $490.00 | $611.46 |