- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.80 / $425.58 / $560.35
| Professional | | $412.80 | $425.58 | $560.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.78 / $1,804.14 / $2,135.89
| Facility | | $1,335.78 | $1,804.14 | $2,135.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.98 / $531.98 / $854.38
| Professional | | $531.98 | $531.98 | $854.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.94 / $511.94 / $546.47
| Facility | | $511.94 | $511.94 | $546.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.72 / $373.72 / $373.72
| Professional | | $373.72 | $373.72 | $373.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.01 / $531.23 / $785.56
| Professional | | $426.01 | $531.23 | $785.56 |