- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.66 / $475.74 / $528.94
| Professional | | $389.66 | $475.74 | $528.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,260.93 / $1,703.03 / $2,016.18
| Facility | | $1,260.93 | $1,703.03 | $2,016.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.84 / $502.16 / $806.49
| Professional | | $426.84 | $502.16 | $806.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.40 / $703.94 / $703.94
| Facility | | $515.40 | $703.94 | $703.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.35 / $703.94 / $703.94
| Professional | | $598.35 | $703.94 | $703.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.13 / $526.90 / $741.54
| Professional | | $402.13 | $526.90 | $741.54 |