- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $812.83
| Professional | | $512.86 | $645.65 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $426.58 / $741.31
| Facility | | $338.84 | $426.58 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,187.76 / $2,187.76
| Professional | | $457.09 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Professional | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Professional | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |