- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.35 / $448.43 / $497.39
| Professional | | $330.35 | $448.43 | $497.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.98 / $1,443.79 / $1,709.28
| Facility | | $1,068.98 | $1,443.79 | $1,709.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.74 / $397.34 / $664.52
| Professional | | $337.74 | $397.34 | $664.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.33 / $626.01 / $626.01
| Facility | | $437.33 | $626.01 | $626.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.99 / $626.01 / $626.01
| Professional | | $456.99 | $626.01 | $626.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.69 / $404.15 / $628.66
| Professional | | $319.69 | $404.15 | $628.66 |