- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.44 / $425.78 / $551.72
| Professional | | $406.44 | $425.78 | $551.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.21 / $1,776.35 / $2,102.98
| Facility | | $1,315.21 | $1,776.35 | $2,102.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.54 / $488.87 / $817.58
| Professional | | $415.54 | $488.87 | $817.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.59 / $458.59 / $538.07
| Facility | | $458.59 | $458.59 | $538.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.77 / $458.59 / $458.59
| Professional | | $334.77 | $458.59 | $458.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.45 / $531.24 / $773.46
| Professional | | $419.45 | $531.24 | $773.46 |