- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.80 / $545.82 / $579.55
| Professional | | $415.80 | $545.82 | $579.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,345.50 / $1,817.28 / $2,151.44
| Facility | | $1,345.50 | $1,817.28 | $2,151.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.12 / $500.12 / $836.42
| Professional | | $500.12 | $500.12 | $836.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.45 / $567.88 / $567.88
| Facility | | $550.45 | $567.88 | $567.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.55 / $414.55 / $414.55
| Professional | | $414.55 | $414.55 | $414.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.14 / $474.77 / $791.28
| Professional | | $341.14 | $474.77 | $791.28 |