- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.71 / $551.60 / $621.55
| Professional | | $482.71 | $551.60 | $621.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.87 / $440.56 / $489.51
| Professional | | $332.87 | $440.56 | $489.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.87 / $606.87 / $606.87
| Facility | | $606.87 | $606.87 | $606.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.33 / $620.22 / $890.32
| Professional | | $483.33 | $620.22 | $890.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.64 / $433.29 / $652.02
| Professional | | $323.64 | $433.29 | $652.02 |