- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.96 / $383.42 / $546.98
| Professional | | $352.96 | $383.42 | $546.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.53 / $55.92 / $55.92
| Professional | | $47.53 | $55.92 | $55.92 |
- 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
- $281.14 / $330.77 / $396.27
| Professional | | $281.14 | $330.77 | $396.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.47 / $262.13 / $526.67
| Professional | | $147.47 | $262.13 | $526.67 |