- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.87 / $520.07 / $585.76
| Professional | | $299.87 | $520.07 | $585.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.36 / $1,885.95 / $2,232.75
| Facility | | $1,396.36 | $1,885.95 | $2,232.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.08 / $645.08 / $893.11
| Professional | | $645.08 | $645.08 | $893.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.11 / $710.11 / $710.11
| Facility | | $710.11 | $710.11 | $710.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.38 / $518.38 / $518.38
| Professional | | $518.38 | $518.38 | $518.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.21 / $492.71 / $821.19
| Professional | | $382.21 | $492.71 | $821.19 |