- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.50 / $314.27 / $383.47
| Professional | | $282.50 | $314.27 | $383.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.16 / $1,234.72 / $1,461.76
| Facility | | $914.16 | $1,234.72 | $1,461.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.06 / $364.06 / $584.72
| Professional | | $364.06 | $364.06 | $584.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.50 / $338.50 / $373.97
| Facility | | $338.50 | $338.50 | $373.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.11 / $338.50 / $338.50
| Professional | | $247.11 | $338.50 | $338.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.54 / $369.26 / $537.62
| Professional | | $291.54 | $369.26 | $537.62 |