- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.45 / $451.28 / $484.41
| Professional | | $352.45 | $451.28 | $484.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.49 / $1,540.39 / $1,823.64
| Facility | | $1,140.49 | $1,540.39 | $1,823.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.92 / $423.92 / $708.98
| Professional | | $423.92 | $423.92 | $708.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.58 / $644.36 / $644.36
| Facility | | $466.58 | $644.36 | $644.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.38 / $644.36 / $644.36
| Professional | | $470.38 | $644.36 | $644.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.86 / $460.67 / $670.72
| Professional | | $374.86 | $460.67 | $670.72 |