- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.37 / $530.12 / $571.98
| Professional | | $421.37 | $530.12 | $571.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,363.51 / $1,841.61 / $2,180.23
| Facility | | $1,363.51 | $1,841.61 | $2,180.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.41 / $629.90 / $872.11
| Professional | | $535.41 | $629.90 | $872.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.53 / $551.53 / $551.53
| Facility | | $551.53 | $551.53 | $551.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.62 / $551.53 / $551.53
| Professional | | $402.62 | $551.53 | $551.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.72 / $481.12 / $801.87
| Professional | | $376.72 | $481.12 | $801.87 |