- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.96 / $460.76 / $664.57
| Professional | | $350.96 | $460.76 | $664.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.12 / $267.12 / $320.04
| Professional | | $267.12 | $267.12 | $320.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.96 / $540.69 / $827.01
| Professional | | $417.96 | $540.69 | $827.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.00 / $36.00 / $41.00
| Facility | | $36.00 | $36.00 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.61 / $660.09 / $1,253.11
| Professional | | $470.61 | $660.09 | $1,253.11 |