- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.60 / $381.88 / $398.53
| Professional | | $293.60 | $381.88 | $398.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.04 / $1,283.16 / $1,519.10
| Facility | | $950.04 | $1,283.16 | $1,519.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.13 / $353.13 / $590.58
| Professional | | $353.13 | $353.13 | $590.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.65 / $528.47 / $528.47
| Facility | | $388.65 | $528.47 | $528.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.78 / $528.47 / $528.47
| Professional | | $385.78 | $528.47 | $528.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.98 / $422.94 / $558.71
| Professional | | $302.98 | $422.94 | $558.71 |