- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.52 / $376.78 / $488.53
| Professional | | $277.52 | $376.78 | $488.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.70 / $480.00 / $665.65
| Professional | | $335.70 | $480.00 | $665.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.65 / $451.65 / $456.00
| Facility | | $451.65 | $451.65 | $456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.22 / $522.44 / $918.02
| Professional | | $294.22 | $522.44 | $918.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.07 / $498.35 / $884.52
| Professional | | $340.07 | $498.35 | $884.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.52 / $376.78 / $664.38
| Professional | | $277.52 | $376.78 | $664.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.07 / $512.70 / $831.87
| Professional | | $340.07 | $512.70 | $831.87 |