- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.18 / $456.81 / $463.44
| Professional | | $340.18 | $456.81 | $463.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.78 / $1,486.71 / $1,760.09
| Facility | | $1,100.78 | $1,486.71 | $1,760.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.62 / $438.38 / $704.05
| Professional | | $372.62 | $438.38 | $704.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.34 / $663.31 / $663.31
| Facility | | $450.34 | $663.31 | $663.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.22 / $663.31 / $663.31
| Professional | | $484.22 | $663.31 | $663.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.62 / $496.20 / $647.35
| Professional | | $365.62 | $496.20 | $647.35 |