- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.46 / $647.66 / $653.54
| Professional | | $481.46 | $647.66 | $653.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.96 / $2,104.21 / $2,491.15
| Facility | | $1,557.96 | $2,104.21 | $2,491.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.38 / $620.45 / $996.48
| Professional | | $527.38 | $620.45 | $996.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.81 / $711.81 / $711.81
| Facility | | $711.81 | $711.81 | $711.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.62 / $711.81 / $711.81
| Professional | | $519.62 | $711.81 | $711.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.96 / $549.74 / $916.23
| Professional | | $455.96 | $549.74 | $916.23 |