- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $478.63 / $812.83
| Professional | | $380.19 | $478.63 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Professional | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $1,380.38
| Facility | | $645.65 | $645.65 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $1,122.02
| Professional | | $467.74 | $467.74 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $562.34 / $1,023.29
| Facility | | $489.78 | $562.34 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $426.58 / $575.44
| Professional | | $251.19 | $426.58 | $575.44 |