- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $436.52 / $676.08
| Professional | | $323.59 | $436.52 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $1,148.15
| Facility | | $501.19 | $501.19 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $870.96
| Professional | | $426.58 | $426.58 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $524.81 / $537.03
| Facility | | $467.74 | $524.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $537.03
| Professional | | $234.42 | $354.81 | $537.03 |