- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $435.46 / $469.82
| Professional | | $346.11 | $435.46 | $469.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,119.98 / $1,512.70 / $1,790.86
| Facility | | $1,119.98 | $1,512.70 | $1,790.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.86 / $416.30 / $696.23
| Professional | | $353.86 | $416.30 | $696.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.23 / $525.23 / $525.23
| Facility | | $525.23 | $525.23 | $525.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.42 / $525.23 / $525.23
| Professional | | $383.42 | $525.23 | $525.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.72 / $482.29 / $658.66
| Professional | | $361.72 | $482.29 | $658.66 |