- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $437.28 / $450.82 / $593.58
| Professional | | $437.28 | $450.82 | $593.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,415.01 / $1,911.16 / $2,262.59
| Facility | | $1,415.01 | $1,911.16 | $2,262.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.53 / $563.53 / $905.05
| Professional | | $563.53 | $563.53 | $905.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.57 / $485.57 / $578.90
| Facility | | $485.57 | $485.57 | $578.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.47 / $485.57 / $485.57
| Professional | | $354.47 | $485.57 | $485.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.28 / $562.75 / $832.16
| Professional | | $451.28 | $562.75 | $832.16 |