- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.66 / $674.65 / $768.79
| Professional | | $514.66 | $674.65 | $768.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.08 / $852.26 / $852.26
| Professional | | $784.08 | $852.26 | $852.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.42 / $581.42 / $927.26
| Facility | | $581.42 | $581.42 | $927.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.22 / $581.42 / $1,038.38
| Professional | | $494.22 | $581.42 | $1,038.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.13 / $499.01 / $691.39
| Professional | | $311.13 | $499.01 | $691.39 |