- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.20 / $256.20 / $324.27
| Professional | | $256.20 | $256.20 | $324.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.61 / $287.76 / $337.03
| Professional | | $242.61 | $287.76 | $337.03 |
- 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
- $321.93 / $372.47 / $571.39
| Professional | | $321.93 | $372.47 | $571.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.20 / $256.20 / $256.20
| Professional | | $256.20 | $256.20 | $256.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.33 / $376.59 / $514.69
| Professional | | $261.33 | $376.59 | $514.69 |