- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.01 / $481.47 / $633.94
| Professional | | $467.01 | $481.47 | $633.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.22 / $2,041.10 / $2,416.42
| Facility | | $1,511.22 | $2,041.10 | $2,416.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.56 / $601.84 / $966.58
| Professional | | $511.56 | $601.84 | $966.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.74 / $544.74 / $618.24
| Facility | | $544.74 | $544.74 | $618.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.66 / $544.74 / $544.74
| Professional | | $397.66 | $544.74 | $544.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.14 / $533.24 / $888.74
| Professional | | $363.14 | $533.24 | $888.74 |