- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.57 / $289.60 / $369.92
| Professional | | $180.57 | $289.60 | $369.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.05 / $235.36 / $235.36
| Professional | | $170.05 | $235.36 | $235.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.74 / $251.74 / $251.74
| Facility | | $251.74 | $251.74 | $251.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.36 / $361.79 / $536.29
| Professional | | $235.36 | $361.79 | $536.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.00 / $1,401.00 / $6,383.00
| Facility | | $320.00 | $1,401.00 | $6,383.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.52 / $252.22 / $384.01
| Professional | | $196.52 | $252.22 | $384.01 |