- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.83 / $271.02 / $352.38
| Professional | | $239.83 | $271.02 | $352.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.69 / $438.20 / $547.76
| Facility | | $401.69 | $438.20 | $547.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.17 / $456.46 / $846.66
| Professional | | $365.17 | $456.46 | $846.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.11 / $481.11 / $481.11
| Facility | | $481.11 | $481.11 | $481.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.28 / $175.28 / $175.28
| Professional | | $175.28 | $175.28 | $175.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.80 / $182.18 / $365.17
| Professional | | $170.80 | $182.18 | $365.17 |