- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.36 / $830.67 / $855.46
| Professional | | $611.36 | $830.67 | $855.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.71 / $867.86 / $1,033.68
| Professional | | $768.71 | $867.86 | $1,033.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.45 / $344.45 / $344.45
| Facility | | $344.45 | $344.45 | $344.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.06 / $344.45 / $1,642.50
| Professional | | $100.06 | $344.45 | $1,642.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.59 / $141.59 / $141.59
| Professional | | $141.59 | $141.59 | $141.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.66 / $595.91 / $695.23
| Professional | | $476.66 | $595.91 | $695.23 |