- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.35 / $342.68 / $521.41
| Professional | | $319.35 | $342.68 | $521.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.22 / $332.22 / $332.22
| Professional | | $332.22 | $332.22 | $332.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $396.27
| Facility | | $330.77 | $330.77 | $396.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.97 / $330.77 / $479.44
| Professional | | $35.97 | $330.77 | $479.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.59 / $260.38 / $601.57
| Professional | | $173.59 | $260.38 | $601.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.04 / $653.75 / $832.05
| Professional | | $590.04 | $653.75 | $832.05 |