- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $281.84 / $371.54
| Professional | | $181.97 | $281.84 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $489.78
| Professional | | $302.00 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Professional | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $331.13 / $2,290.87
| Facility | | $181.97 | $331.13 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $281.84 / $537.03
| Professional | | $199.53 | $281.84 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $234.42 / $371.54
| Facility | | $30.20 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $281.84 / $436.52
| Professional | | $218.78 | $281.84 | $436.52 |