- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $380.19 / $478.63
| Professional | | $309.03 | $380.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $630.96
| Facility | | $416.87 | $416.87 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $416.87
| Professional | | $302.00 | $302.00 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $660.69 / $851.14
| Professional | | $616.60 | $660.69 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $426.58 / $501.19
| Facility | | $416.87 | $426.58 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $645.65 / $1,778.28
| Professional | | $295.12 | $645.65 | $1,778.28 |