- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.47 / $422.83 / $497.89
| Professional | | $228.47 | $422.83 | $497.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.52 / $366.87 / $518.65
| Professional | | $333.52 | $366.87 | $518.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.23 / $213.23 / $213.23
| Professional | | $208.23 | $213.23 | $213.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.83 / $563.77 / $1,001.54
| Facility | | $422.83 | $563.77 | $1,001.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.69 / $292.86 / $902.99
| Professional | | $184.69 | $292.86 | $902.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.53 / $273.20 / $422.83
| Professional | | $173.53 | $273.20 | $422.83 |