- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.87 / $642.83 / $905.45
| Professional | | $476.87 | $642.83 | $905.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.26 / $818.16 / $1,024.96
| Professional | | $754.26 | $818.16 | $1,024.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.25 / $670.25 / $897.30
| Facility | | $670.25 | $670.25 | $897.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.71 / $670.25 / $897.30
| Professional | | $569.71 | $670.25 | $897.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.74 / $657.43 / $1,095.72
| Professional | | $496.74 | $657.43 | $1,095.72 |