- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.50 / $366.50 / $395.28
| Professional | | $366.50 | $366.50 | $395.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $630.37
| Professional | | $400.00 | $500.00 | $630.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.06 / $407.81 / $407.81
| Facility | | $320.06 | $407.81 | $407.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.27 / $407.81 / $407.81
| Professional | | $49.27 | $407.81 | $407.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.71 / $366.50 / $439.80
| Facility | | $181.71 | $366.50 | $439.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.00 / $338.48 / $338.48
| Professional | | $43.00 | $338.48 | $338.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.90 / $234.53 / $334.86
| Professional | | $168.90 | $234.53 | $334.86 |