- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.77 / $360.88 / $383.46
| Professional | | $306.77 | $360.88 | $383.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.57 / $350.35 / $467.11
| Facility | | $38.57 | $350.35 | $467.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.54 / $306.56 / $408.72
| Professional | | $41.54 | $306.56 | $408.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.00 / $234.00 / $741.89
| Facility | | $234.00 | $234.00 | $741.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.00 / $489.07 / $3,109.48
| Professional | | $234.00 | $489.07 | $3,109.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.35 / $323.39 / $438.81
| Professional | | $241.35 | $323.39 | $438.81 |