- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $257.04 / $416.87
| Professional | | $204.17 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $851.14
| Facility | | $354.81 | $354.81 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $575.44
| Professional | | $257.04 | $257.04 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $269.15 / $630.96
| Facility | | $154.88 | $269.15 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $331.13
| Professional | | $151.36 | $213.80 | $331.13 |