- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $478.63
| Professional | | $309.03 | $416.87 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $512.86
| Facility | | $501.19 | $501.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $501.19
| Professional | | $426.58 | $426.58 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $691.83 / $933.25
| Professional | | $549.54 | $691.83 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $467.74 / $549.54
| Facility | | $354.81 | $467.74 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $524.81 / $1,479.11
| Professional | | $245.47 | $524.81 | $1,479.11 |