- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.79 / $365.86 / $394.73
| Professional | | $290.79 | $365.86 | $394.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $940.98 / $1,270.94 / $1,504.63
| Facility | | $940.98 | $1,270.94 | $1,504.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.46 / $565.72 / $584.96
| Professional | | $538.46 | $565.72 | $584.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.63 / $380.63 / $380.63
| Facility | | $380.63 | $380.63 | $380.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.86 / $380.63 / $380.63
| Professional | | $277.86 | $380.63 | $380.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.35 / $332.03 / $553.39
| Professional | | $246.35 | $332.03 | $553.39 |