- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.60 / $302.42 / $439.68
| Professional | | $241.60 | $302.42 | $439.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.28 / $480.28 / $480.28
| Professional | | $480.28 | $480.28 | $480.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.55 / $354.55 / $465.35
| Facility | | $354.55 | $354.55 | $465.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.37 / $301.37 / $427.32
| Professional | | $301.37 | $301.37 | $427.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.16 / $456.63 / $574.08
| Professional | | $355.16 | $456.63 | $574.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.39 / $356.01 / $542.75
| Professional | | $271.39 | $356.01 | $542.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.63 / $426.64 / $430.75
| Professional | | $421.63 | $426.64 | $430.75 |