- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $257.04 / $524.81
| Professional | | $181.97 | $257.04 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $1,174.90
| Facility | | $1,174.90 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $870.96
| Professional | | $234.42 | $309.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $933.25
| Professional | | $186.21 | $288.40 | $933.25 |