- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.02 / $575.17 / $632.58
| Professional | | $466.02 | $575.17 | $632.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,507.98 / $2,036.72 / $2,411.23
| Facility | | $1,507.98 | $2,036.72 | $2,411.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.47 / $600.54 / $964.51
| Professional | | $510.47 | $600.54 | $964.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.92 / $694.09 / $694.09
| Facility | | $616.92 | $694.09 | $694.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.69 / $694.09 / $694.09
| Professional | | $506.69 | $694.09 | $694.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.92 / $679.75 / $886.84
| Professional | | $480.92 | $679.75 | $886.84 |