- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.87 / $305.87 / $404.84
| Professional | | $305.87 | $305.87 | $404.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.25 / $538.27 / $545.17
| Professional | | $455.25 | $538.27 | $545.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.38 / $427.61 / $537.69
| Professional | | $423.38 | $427.61 | $537.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.87 / $404.84 / $481.58
| Facility | | $305.87 | $404.84 | $481.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.47 / $193.98 / $2,424.76
| Professional | | $145.47 | $193.98 | $2,424.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.63 / $151.82 / $482.02
| Professional | | $142.63 | $151.82 | $482.02 |