- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.54 / $461.73 / $507.53
| Professional | | $459.54 | $461.73 | $507.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.26 / $1,073.26 / $1,374.53
| Facility | | $1,073.26 | $1,073.26 | $1,374.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.94 / $643.54 / $1,568.01
| Professional | | $545.94 | $643.54 | $1,568.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.90 / $662.76 / $957.28
| Professional | | $423.90 | $662.76 | $957.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.70 / $632.69 / $957.28
| Professional | | $516.70 | $632.69 | $957.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.79 / $601.24 / $1,747.86
| Professional | | $517.79 | $601.24 | $1,747.86 |