- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.39 / $400.00 / $401.62
| Professional | | $289.39 | $400.00 | $401.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.91 / $161.38 / $634.67
| Facility | | $139.91 | $161.38 | $634.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.01 / $280.01 / $350.02
| Professional | | $280.01 | $280.01 | $350.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $401.62 / $401.62 / $514.07
| Facility | | $401.62 | $401.62 | $514.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $78.00
| Professional | | $55.00 | $55.00 | $78.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.89 / $429.29 / $524.42
| Facility | | $307.89 | $429.29 | $524.42 |