- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $616.60
| Professional | | $331.13 | $457.09 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $575.44 / $575.44
| Facility | | $562.34 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $588.84
| Professional | | $416.87 | $416.87 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $1,023.29
| Professional | | $602.56 | $741.31 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $467.74 / $602.56
| Facility | | $407.38 | $467.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $575.44 / $1,584.89
| Professional | | $263.03 | $575.44 | $1,584.89 |