- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $458.24 / $576.53 / $622.02
| Professional | | $458.24 | $576.53 | $622.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,482.82 / $2,002.73 / $2,371.00
| Facility | | $1,482.82 | $2,002.73 | $2,371.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.26 / $685.01 / $948.41
| Professional | | $582.26 | $685.01 | $948.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.41 / $695.41 / $695.41
| Facility | | $695.41 | $695.41 | $695.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.65 / $695.41 / $695.41
| Professional | | $507.65 | $695.41 | $695.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.68 / $523.22 / $872.04
| Professional | | $409.68 | $523.22 | $872.04 |