- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.50 / $326.52 / $703.83
| Professional | | $267.50 | $326.52 | $703.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.12 / $232.12 / $232.12
| Facility | | $232.12 | $232.12 | $232.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.30 / $232.12 / $911.25
| Professional | | $197.30 | $232.12 | $911.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.31 / $834.31 / $834.31
| Professional | | $834.31 | $834.31 | $834.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.04 / $571.36 / $571.36
| Professional | | $29.04 | $571.36 | $571.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.91 / $415.97 / $503.60
| Professional | | $330.91 | $415.97 | $503.60 |