- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.58 / $334.62 / $440.59
| Professional | | $324.58 | $334.62 | $440.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.30 / $1,418.59 / $1,679.44
| Facility | | $1,050.30 | $1,418.59 | $1,679.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.43 / $485.21 / $671.78
| Professional | | $412.43 | $485.21 | $671.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.88 / $372.88 / $429.68
| Facility | | $372.88 | $372.88 | $429.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.20 / $372.88 / $372.88
| Professional | | $272.20 | $372.88 | $372.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.07 / $370.61 / $617.67
| Professional | | $247.07 | $370.61 | $617.67 |