- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.63 / $319.05 / $328.57
| Professional | | $283.63 | $319.05 | $328.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.33 / $333.33 / $437.28
| Professional | | $333.33 | $333.33 | $437.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.71 / $358.71 / $358.71
| Facility | | $358.71 | $358.71 | $358.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.89 / $358.71 / $612.38
| Professional | | $304.89 | $358.71 | $612.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.83 / $216.24 / $293.47
| Facility | | $28.83 | $216.24 | $293.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.45 / $270.02 / $450.03
| Professional | | $199.45 | $270.02 | $450.03 |