- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.87 / $596.70 / $786.39
| Professional | | $444.87 | $596.70 | $786.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,605.33 / $2,168.21 / $2,566.92
| Facility | | $1,605.33 | $2,168.21 | $2,566.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.85 / $767.95 / $1,026.78
| Professional | | $554.85 | $767.95 | $1,026.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.14 / $517.14 / $517.14
| Professional | | $517.14 | $517.14 | $517.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.13 / $648.42 / $944.09
| Professional | | $414.13 | $648.42 | $944.09 |