- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.21 / $411.16 / $687.98
| Professional | | $227.21 | $411.16 | $687.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.79 / $329.17 / $487.21
| Professional | | $279.79 | $329.17 | $487.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $419.69 / $492.79 / $729.08
| Professional | 50 | $419.69 | $492.79 | $729.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.05 / $712.05 / $712.05
| Facility | | $712.05 | $712.05 | $712.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.09 / $542.08 / $875.60
| Professional | | $387.09 | $542.08 | $875.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.20 / $525.14 / $817.12
| Professional | | $311.20 | $525.14 | $817.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.21 / $391.76 / $669.34
| Professional | | $227.21 | $391.76 | $669.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.80 / $586.99 / $759.04
| Professional | | $350.80 | $586.99 | $759.04 |