- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.73 / $361.48 / $463.43
| Professional | | $253.73 | $361.48 | $463.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.67 / $391.67 / $412.28
| Facility | | $391.67 | $391.67 | $412.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.20 / $408.20 / $408.20
| Professional | | $408.20 | $408.20 | $408.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.28 / $175.28 / $175.28
| Professional | | $175.28 | $175.28 | $175.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.41 / $391.52 / $481.58
| Facility | | $350.41 | $391.52 | $481.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.63 / $232.08 / $2,424.76
| Professional | | $142.63 | $232.08 | $2,424.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.45 / $219.55 / $311.02
| Professional | | $121.45 | $219.55 | $311.02 |