- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.57 / $403.14 / $443.29
| Professional | | $326.57 | $403.14 | $443.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.74 / $1,427.26 / $1,689.72
| Facility | | $1,056.74 | $1,427.26 | $1,689.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.95 / $488.18 / $675.89
| Professional | | $414.95 | $488.18 | $675.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.41 / $419.41 / $432.33
| Facility | | $419.41 | $419.41 | $432.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.17 / $306.17 / $306.17
| Professional | | $306.17 | $306.17 | $306.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.01 / $446.48 / $621.46
| Professional | | $337.01 | $446.48 | $621.46 |