- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $346.74 / $776.25
| Professional | | $234.42 | $346.74 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $1,071.52
| Professional | | $331.13 | $331.13 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $380.19 / $575.44
| Professional | | $234.42 | $380.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $389.05 / $501.19
| Professional | | $295.12 | $389.05 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $691.83
| Professional | | $281.84 | $363.08 | $691.83 |