- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.54 / $416.74 / $546.41
| Professional | | $402.54 | $416.74 | $546.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,302.58 / $1,759.28 / $2,082.78
| Facility | | $1,302.58 | $1,759.28 | $2,082.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.54 / $484.16 / $809.72
| Professional | | $411.54 | $484.16 | $809.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.58 / $500.58 / $532.87
| Facility | | $500.58 | $500.58 | $532.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.42 / $500.58 / $500.58
| Professional | | $365.42 | $500.58 | $500.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.41 / $520.92 / $766.03
| Professional | | $415.41 | $520.92 | $766.03 |