- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $436.52 / $549.54
| Professional | | $346.74 | $436.52 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $630.96
| Facility | | $446.68 | $446.68 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $457.09
| Professional | | $380.19 | $380.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $776.25 / $977.24
| Professional | | $676.08 | $776.25 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $575.44
| Facility | | $478.63 | $478.63 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $645.65 / $1,778.28
| Professional | | $295.12 | $645.65 | $1,778.28 |