- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $551.53 / $656.70 / $748.67
| Professional | | $551.53 | $656.70 | $748.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.70 / $2,410.48 / $2,853.72
| Facility | | $1,784.70 | $2,410.48 | $2,853.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.38 / $663.38 / $1,109.44
| Professional | | $663.38 | $663.38 | $1,109.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.79 / $719.79 / $730.14
| Facility | | $719.79 | $719.79 | $730.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.45 / $719.79 / $719.79
| Professional | | $525.45 | $719.79 | $719.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.17 / $720.88 / $1,049.57
| Professional | | $569.17 | $720.88 | $1,049.57 |