- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.91 / $441.04 / $446.62
| Professional | | $324.91 | $441.04 | $446.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,051.38 / $1,420.03 / $1,681.15
| Facility | | $1,051.38 | $1,420.03 | $1,681.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.18 / $390.80 / $653.58
| Professional | | $332.18 | $390.80 | $653.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.13 / $530.41 / $530.41
| Facility | | $430.13 | $530.41 | $530.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.20 / $387.20 / $387.20
| Professional | | $387.20 | $387.20 | $387.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.21 / $424.68 / $618.30
| Professional | | $349.21 | $424.68 | $618.30 |