- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $245.47 / $1,737.80
| Professional | | $194.98 | $245.47 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Professional | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $446.68 / $1,479.11
| Facility | | $380.19 | $446.68 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $371.54 / $380.19
| Professional | | $302.00 | $371.54 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $323.59 / $794.33
| Facility | | $263.03 | $323.59 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $323.59 / $794.33
| Professional | | $263.03 | $323.59 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $446.68 / $1,479.11
| Facility | | $234.42 | $446.68 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $416.87
| Professional | | $234.42 | $234.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $263.03
| Professional | | $109.65 | $109.65 | $263.03 |