- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.87 / $429.48 / $484.70
| Professional | | $337.87 | $429.48 | $484.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.49 / $366.87 / $506.28
| Professional | | $293.49 | $366.87 | $506.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.66 / $752.27 / $810.14
| Facility | | $578.66 | $752.27 | $810.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.66 / $636.54 / $723.34
| Professional | | $578.66 | $636.54 | $723.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $213.23 / $593.61
| Professional | | $213.23 | $213.23 | $593.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.75 / $266.93 / $352.04
| Professional | | $147.75 | $266.93 | $352.04 |