- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $269.15 / $323.59
| Professional | | $251.19 | $269.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $371.54 / $467.74
| Professional | | $54.95 | $371.54 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $229.09 / $331.13
| Facility | | $57.54 | $229.09 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $371.54 / $660.69
| Professional | | $234.42 | $371.54 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $19,952.62
| Facility | | $19,952.62 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,801.89
| Professional | | $3,311.31 | $3,311.31 | $3,801.89 |