- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $446.68
| Professional | | $245.47 | $331.13 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $407.38
| Facility | | $371.54 | $371.54 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $389.05
| Professional | | $275.42 | $275.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $549.54 / $741.31
| Professional | | $436.52 | $549.54 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $275.42 / $371.54
| Facility | | $269.15 | $275.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $416.87 / $1,174.90
| Professional | | $194.98 | $416.87 | $1,174.90 |