- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.33 / $365.85 / $388.74
| Professional | | $264.33 | $365.85 | $388.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.36 / $355.15 / $473.54
| Facility | | $39.36 | $355.15 | $473.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.39 / $310.76 / $414.35
| Professional | | $42.39 | $310.76 | $414.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.50 / $292.50 / $693.67
| Facility | | $292.50 | $292.50 | $693.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.50 / $292.50 / $418.36
| Professional | | $292.50 | $292.50 | $418.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.96 / $295.31 / $401.01
| Professional | | $207.96 | $295.31 | $401.01 |