- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.17 / $235.17 / $297.39
| Professional | | $235.17 | $235.17 | $297.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.67 / $155.07 / $155.07
| Professional | | $50.67 | $155.07 | $155.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.05 / $712.05 / $712.05
| Facility | | $712.05 | $712.05 | $712.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.62 / $227.49 / $348.98
| Professional | | $196.62 | $227.49 | $348.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.17 / $235.17 / $235.17
| Professional | | $235.17 | $235.17 | $235.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.02 / $213.18 / $318.57
| Professional | | $147.02 | $213.18 | $318.57 |