- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.17 / $327.02 / $377.87
| Professional | | $288.17 | $327.02 | $377.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.50 / $337.43 / $449.90
| Facility | | $43.50 | $337.43 | $449.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.06 / $353.40 / $484.51
| Professional | | $38.06 | $353.40 | $484.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.55 / $354.55 / $697.01
| Facility | | $354.55 | $354.55 | $697.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.55 / $427.32 / $465.35
| Professional | | $354.55 | $427.32 | $465.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.14 / $326.20 / $574.76
| Professional | | $282.14 | $326.20 | $574.76 |