- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $257.04 / $575.44
| Professional | | $229.09 | $257.04 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $758.58
| Professional | | $436.52 | $630.96 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $389.05 / $575.44
| Professional | | $346.74 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $3,090.30
| Facility | | $1,288.25 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $912.01
| Professional | | $295.12 | $467.74 | $912.01 |