- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.50 / $352.50 / $565.47
| Professional | | $216.50 | $352.50 | $565.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.66 / $723.66 / $926.80
| Facility | | $723.66 | $723.66 | $926.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.17 / $484.65 / $1,397.16
| Professional | | $399.17 | $484.65 | $1,397.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.64 / $481.68 / $1,369.88
| Professional | | $295.64 | $481.68 | $1,369.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.76 / $542.74 / $1,369.88
| Professional | | $308.76 | $542.74 | $1,369.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.42 / $444.43 / $1,536.88
| Professional | | $363.42 | $444.43 | $1,536.88 |