- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.13 / $343.47 / $427.07
| Professional | | $258.13 | $343.47 | $427.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.93 / $523.05 / $523.05
| Professional | | $372.93 | $523.05 | $523.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.00 / $234.00 / $234.00
| Facility | | $234.00 | $234.00 | $234.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.90 / $234.00 / $966.09
| Professional | | $198.90 | $234.00 | $966.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.06 / $378.41 / $686.93
| Facility | | $188.06 | $378.41 | $686.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.06 / $188.06 / $188.06
| Professional | | $188.06 | $188.06 | $188.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.85 / $686.93 / $996.05
| Professional | | $480.85 | $686.93 | $996.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.02 / $291.29 / $438.81
| Professional | | $263.02 | $291.29 | $438.81 |