- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.14 / $360.01 / $388.42
| Professional | | $286.14 | $360.01 | $388.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.95 / $1,250.63 / $1,480.60
| Facility | | $925.95 | $1,250.63 | $1,480.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.54 / $344.17 / $575.61
| Professional | | $292.54 | $344.17 | $575.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.07 / $434.07 / $434.07
| Facility | | $434.07 | $434.07 | $434.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.87 / $434.07 / $434.07
| Professional | | $316.87 | $434.07 | $434.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.30 / $398.72 / $544.54
| Professional | | $295.30 | $398.72 | $544.54 |