- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.75 / $435.11 / $856.34
| Professional | | $316.75 | $435.11 | $856.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.72 / $422.72 / $422.72
| Facility | | $422.72 | $422.72 | $422.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.31 / $359.31 / $1,326.56
| Professional | | $359.31 | $359.31 | $1,326.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.40 / $581.40 / $581.40
| Professional | | $581.40 | $581.40 | $581.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.92 / $687.92 / $687.92
| Professional | | $687.92 | $687.92 | $687.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.85 / $492.69 / $952.27
| Professional | | $391.85 | $492.69 | $952.27 |