- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.44 / $316.89 / $431.70
| Professional | | $220.44 | $316.89 | $431.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.45 / $373.92 / $393.60
| Professional | | $265.45 | $373.92 | $393.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $333.25 / $333.25 / $333.25
| Facility | | $333.25 | $333.25 | $333.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.26 / $333.25 / $376.21
| Professional | | $283.26 | $333.25 | $376.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.89 / $431.72 / $2,250.42
| Facility | | $316.89 | $431.72 | $2,250.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.84 / $271.83 / $495.52
| Professional | | $206.84 | $271.83 | $495.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.55 / $258.77 / $442.43
| Professional | | $192.55 | $258.77 | $442.43 |