- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.57 / $242.86 / $319.77
| Professional | | $235.57 | $242.86 | $319.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.20 / $458.29 / $473.87
| Professional | | $436.20 | $458.29 | $473.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.68 / $252.68 / $252.68
| Facility | | $252.68 | $252.68 | $252.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.10 / $194.10 / $252.68
| Professional | | $194.10 | $194.10 | $252.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.11 / $303.58 / $448.30
| Professional | | $243.11 | $303.58 | $448.30 |