- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.73 / $343.70 / $410.94
| Professional | | $302.73 | $343.70 | $410.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.61 / $1,323.10 / $1,566.40
| Facility | | $979.61 | $1,323.10 | $1,566.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.68 / $452.56 / $626.57
| Professional | | $384.68 | $452.56 | $626.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.76 / $493.58 / $493.58
| Facility | | $400.76 | $493.58 | $493.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.31 / $493.58 / $493.58
| Professional | | $360.31 | $493.58 | $493.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.01 / $763.01 / $763.01
| Facility | | $763.01 | $763.01 | $763.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.42 / $395.69 / $576.11
| Professional | | $312.42 | $395.69 | $576.11 |