- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.76 / $252.34 / $912.60
| Professional | | $244.76 | $252.34 | $912.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.22 / $476.16 / $492.35
| Professional | | $453.22 | $476.16 | $492.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.38 / $373.38 / $373.38
| Facility | | $373.38 | $373.38 | $373.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.37 / $317.37 / $317.37
| Professional | | $317.37 | $317.37 | $317.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.82 / $315.42 / $465.79
| Professional | | $218.82 | $315.42 | $465.79 |