- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.66 / $529.69 / $600.30
| Professional | | $469.66 | $529.69 | $600.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.28 / $674.05 / $758.30
| Professional | | $421.28 | $674.05 | $758.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.19 / $706.25 / $1,300.25
| Facility | | $473.19 | $706.25 | $1,300.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.63 / $296.63 / $3,517.13
| Professional | | $296.63 | $296.63 | $3,517.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.63 / $296.63 / $423.75
| Professional | | $296.63 | $296.63 | $423.75 |