- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.39 / $707.64 / $931.73
| Professional | | $686.39 | $707.64 | $931.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,221.08 / $2,999.88 / $3,551.51
| Facility | | $2,221.08 | $2,999.88 | $3,551.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.08 / $1,026.08 / $1,420.63
| Professional | | $1,026.08 | $1,026.08 | $1,420.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.22 / $736.22 / $908.66
| Facility | | $736.22 | $736.22 | $908.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.44 / $736.22 / $736.22
| Professional | | $537.44 | $736.22 | $736.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.72 / $783.73 / $1,306.21
| Professional | | $533.72 | $783.73 | $1,306.21 |