- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.32 / $528.29 / $571.77
| Professional | | $394.32 | $528.29 | $571.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.23 / $1,472.23 / $1,482.51
| Facility | | $1,472.23 | $1,472.23 | $1,482.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,583.74 / $1,583.74 / $1,583.74
| Professional | | $1,583.74 | $1,583.74 | $1,583.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.13 / $761.08 / $992.03
| Professional | | $496.13 | $761.08 | $992.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.70 / $673.07 / $992.03
| Professional | | $461.70 | $673.07 | $992.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.12 / $623.08 / $1,811.35
| Professional | | $607.12 | $623.08 | $1,811.35 |