- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.93 / $429.66 / $544.96
| Professional | | $313.93 | $429.66 | $544.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.68 / $651.04 / $741.47
| Professional | | $507.68 | $651.04 | $741.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.30 / $651.54 / $744.62
| Professional | | $614.30 | $651.54 | $744.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $198.69 / $599.54
| Professional | | $32.34 | $198.69 | $599.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $946.29 / $946.29 / $946.29
| Facility | 26 | $946.29 | $946.29 | $946.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.42 / $587.54 / $695.87
| Professional | | $499.42 | $587.54 | $695.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.33 / $536.40 / $750.04
| Professional | | $377.33 | $536.40 | $750.04 |