- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.58 / $364.72 / $410.73
| Professional | | $302.58 | $364.72 | $410.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.13 / $1,322.48 / $1,565.66
| Facility | | $979.13 | $1,322.48 | $1,565.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.44 / $389.93 / $626.27
| Professional | | $331.44 | $389.93 | $626.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.21 / $436.96 / $436.96
| Facility | | $400.21 | $436.96 | $436.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.98 / $436.96 / $436.96
| Professional | | $318.98 | $436.96 | $436.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.26 / $395.50 / $575.83
| Professional | | $312.26 | $395.50 | $575.83 |