- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $446.68
| Professional | | $234.42 | $338.84 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $478.63 / $478.63
| Facility | | $416.87 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $478.63
| Professional | | $346.74 | $346.74 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $549.54 / $758.58
| Professional | | $446.68 | $549.54 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $398.11
| Facility | | $281.84 | $354.81 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $426.58 / $1,174.90
| Professional | | $194.98 | $426.58 | $1,174.90 |