- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.21 / $411.38 / $530.41
| Professional | | $227.21 | $411.38 | $530.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.41 / $1,707.76 / $2,021.78
| Facility | | $1,264.41 | $1,707.76 | $2,021.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.50 / $584.12 / $808.72
| Professional | | $496.50 | $584.12 | $808.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.00 / $460.00 / $517.28
| Facility | | $460.00 | $460.00 | $517.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.80 / $460.00 / $460.00
| Professional | | $335.80 | $460.00 | $460.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.26 / $446.15 / $743.59
| Professional | | $310.26 | $446.15 | $743.59 |