- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $269.15 / $446.68
| Professional | | $257.04 | $269.15 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Professional | | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $616.60
| Professional | | $173.78 | $288.40 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $269.15 / $338.84
| Professional | | $181.97 | $269.15 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $234.42 / $446.68
| Facility | | $23.44 | $234.42 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $616.60
| Professional | | $173.78 | $288.40 | $616.60 |