- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.71 / $245.71 / $283.51
| Professional | | $245.71 | $245.71 | $283.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.36 / $407.36 / $407.36
| Professional | | $407.36 | $407.36 | $407.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.76 / $319.76 / $370.07
| Facility | | $319.76 | $319.76 | $370.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.42 / $233.42 / $313.74
| Professional | | $233.42 | $233.42 | $313.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.76 / $319.76 / $370.07
| Facility | | $319.76 | $319.76 | $370.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.42 / $233.42 / $313.74
| Professional | | $233.42 | $233.42 | $313.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.46 / $318.72 / $582.08
| Professional | | $167.46 | $318.72 | $582.08 |