- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.33 / $403.70 / $489.12
| Professional | | $360.33 | $403.70 | $489.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.99 / $1,574.85 / $1,864.43
| Facility | | $1,165.99 | $1,574.85 | $1,864.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.65 / $538.65 / $745.78
| Professional | | $538.65 | $538.65 | $745.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.01 / $420.01 / $477.02
| Facility | | $420.01 | $420.01 | $477.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.61 / $420.01 / $420.01
| Professional | | $306.61 | $420.01 | $420.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.86 / $470.98 / $685.72
| Professional | | $371.86 | $470.98 | $685.72 |