- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.71 / $582.70 / $948.18
| Professional | | $527.71 | $582.70 | $948.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.21 / $536.21 / $1,069.26
| Facility | | $536.21 | $536.21 | $1,069.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.14 / $484.14 / $536.21
| Professional | | $484.14 | $484.14 | $536.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.21 / $536.21 / $1,069.26
| Facility | | $536.21 | $536.21 | $1,069.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.14 / $525.24 / $685.10
| Professional | | $484.14 | $525.24 | $685.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.14 / $484.14 / $484.14
| Professional | | $484.14 | $484.14 | $484.14 |