- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.75 / $401.40 / $467.98
| Professional | | $344.75 | $401.40 | $467.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,115.58 / $1,506.75 / $1,783.82
| Facility | | $1,115.58 | $1,506.75 | $1,783.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.06 / $515.37 / $713.54
| Professional | | $438.06 | $515.37 | $713.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.05 / $440.05 / $440.05
| Facility | | $440.05 | $440.05 | $440.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.24 / $440.05 / $440.05
| Professional | | $321.24 | $440.05 | $440.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.78 / $450.61 / $656.07
| Professional | | $355.78 | $450.61 | $656.07 |