- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.25 / $392.85 / $432.01
| Professional | | $318.25 | $392.85 | $432.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.83 / $1,390.93 / $1,646.71
| Facility | | $1,029.83 | $1,390.93 | $1,646.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.14 / $410.14 / $658.69
| Professional | | $410.14 | $410.14 | $658.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.71 / $408.71 / $421.30
| Facility | | $408.71 | $408.71 | $421.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.36 / $408.71 / $408.71
| Professional | | $298.36 | $408.71 | $408.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.52 / $380.71 / $605.64
| Professional | | $284.52 | $380.71 | $605.64 |