- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.11 / $227.51 / $596.27
| Professional | | $206.11 | $227.51 | $596.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.32 / $823.16 / $1,032.76
| Professional | | $796.32 | $823.16 | $1,032.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.64 / $531.64 / $531.64
| Facility | | $531.64 | $531.64 | $531.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.82 / $540.82 / $540.82
| Professional | | $540.82 | $540.82 | $540.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.80 / $938.10 / $1,439.09
| Professional | | $810.80 | $938.10 | $1,439.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.27 / $596.27 / $596.27
| Professional | | $596.27 | $596.27 | $596.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.77 / $740.62 / $957.69
| Professional | | $510.77 | $740.62 | $957.69 |