- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.45 / $518.75 / $581.91
| Professional | | $305.45 | $518.75 | $581.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.21 / $1,873.59 / $2,218.12
| Facility | | $1,387.21 | $1,873.59 | $2,218.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.85 / $640.85 / $887.26
| Professional | | $640.85 | $640.85 | $887.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $567.52 / $632.51 / $632.51
| Facility | | $567.52 | $632.51 | $632.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.73 / $632.51 / $632.51
| Professional | | $461.73 | $632.51 | $632.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.35 / $524.47 / $815.81
| Professional | | $389.35 | $524.47 | $815.81 |