- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.16 / $483.61 / $488.55
| Professional | | $403.16 | $483.61 | $488.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $213.23 / $213.23
| Professional | | $213.23 | $213.23 | $213.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.33 / $419.25 / $585.75
| Facility | | $282.33 | $419.25 | $585.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $518.65 / $563.77
| Professional | | $213.23 | $518.65 | $563.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.31 / $221.62 / $317.95
| Professional | | $200.31 | $221.62 | $317.95 |