- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.89 / $487.13 / $608.91
| Professional | | $369.89 | $487.13 | $608.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.49 / $473.49 / $802.35
| Facility | | $473.49 | $473.49 | $802.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,322.00 / $1,322.00 / $1,322.00
| Professional | | $1,322.00 | $1,322.00 | $1,322.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.81 / $348.00 / $369.03
| Facility | | $293.81 | $348.00 | $369.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.00 / $369.03 / $501.64
| Professional | | $267.00 | $369.03 | $501.64 |