- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.62 / $481.70 / $585.89
| Professional | | $431.62 | $481.70 | $585.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.69 / $1,886.43 / $2,233.30
| Facility | | $1,396.69 | $1,886.43 | $2,233.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.44 / $645.22 / $893.33
| Professional | | $548.44 | $645.22 | $893.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.14 / $501.14 / $571.40
| Facility | | $501.14 | $501.14 | $571.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.83 / $501.14 / $501.14
| Professional | | $365.83 | $501.14 | $501.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.30 / $493.25 / $821.39
| Professional | | $363.30 | $493.25 | $821.39 |