- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $457.09 / $741.31
| Professional | | $371.54 | $457.09 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Professional | | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $1,380.38
| Facility | | $630.96 | $630.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $1,122.02
| Professional | | $457.09 | $457.09 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $436.52 / $1,023.29
| Facility | | $257.04 | $436.52 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $562.34
| Professional | | $251.19 | $380.19 | $562.34 |