- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $537.03
| Professional | | $275.42 | $398.11 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $602.56
| Facility | | $398.11 | $398.11 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $416.87
| Professional | | $295.12 | $295.12 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $794.33 / $851.14
| Professional | | $645.65 | $794.33 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $426.58 / $512.86
| Facility | | $371.54 | $426.58 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $616.60 / $1,698.24
| Professional | | $281.84 | $616.60 | $1,698.24 |