- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.85 / $263.82 / $1,400.53
| Professional | | $167.85 | $263.82 | $1,400.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.21 / $432.21 / $432.21
| Facility | | $432.21 | $432.21 | $432.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.71 / $368.41 / $670.53
| Professional | | $224.71 | $368.41 | $670.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.00 / $282.02 / $407.96
| Facility | | $170.00 | $282.02 | $407.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.26 / $442.14 / $736.77
| Professional | | $284.26 | $442.14 | $736.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.60 / $420.76 / $535.51
| Professional | | $336.60 | $420.76 | $535.51 |