- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.45 / $410.33 / $433.80
| Professional | | $296.45 | $410.33 | $433.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.68 / $52.84 / $338.98
| Facility | | $36.68 | $52.84 | $338.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.50 / $46.24 / $365.06
| Professional | | $39.50 | $46.24 | $365.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.81 / $407.81 / $627.46
| Facility | | $407.81 | $407.81 | $627.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.24 / $407.81 / $2,623.96
| Professional | | $47.24 | $407.81 | $2,623.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.63 / $273.26 / $452.03
| Professional | | $204.63 | $273.26 | $452.03 |