- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.25 / $418.42 / $423.72
| Professional | | $308.25 | $418.42 | $423.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.47 / $1,347.19 / $1,594.92
| Facility | | $997.47 | $1,347.19 | $1,594.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.68 / $460.80 / $637.98
| Professional | | $391.68 | $460.80 | $637.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.07 / $448.56 / $448.56
| Facility | | $408.07 | $448.56 | $448.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.45 / $448.56 / $448.56
| Professional | | $327.45 | $448.56 | $448.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.30 / $433.89 / $586.60
| Professional | | $331.30 | $433.89 | $586.60 |