- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.83 / $362.28 / $525.89
| Professional | | $289.83 | $362.28 | $525.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.02 / $395.81 / $524.50
| Facility | | $184.02 | $395.81 | $524.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.00 / $1,122.00 / $8,263.84
| Professional | | $299.00 | $1,122.00 | $8,263.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.55 / $225.55 / $318.00
| Facility | | $225.55 | $225.55 | $318.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.55 / $328.00 / $369.46
| Professional | | $225.55 | $328.00 | $369.46 |