- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.09 / $392.74 / $456.22
| Professional | | $336.09 | $392.74 | $456.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,087.56 / $1,468.88 / $1,738.98
| Facility | | $1,087.56 | $1,468.88 | $1,738.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.06 / $502.42 / $695.60
| Professional | | $427.06 | $502.42 | $695.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.60 / $408.60 / $444.93
| Facility | | $408.60 | $408.60 | $444.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.27 / $408.60 / $408.60
| Professional | | $298.27 | $408.60 | $408.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.20 / $383.75 / $639.58
| Professional | | $296.20 | $383.75 | $639.58 |