- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.83 / $451.14 / $614.60
| Professional | | $313.83 | $451.14 | $614.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.58 / $372.93 / $413.95
| Professional | | $319.58 | $372.93 | $413.95 |
- 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 / $198.90 / $234.00
| Professional | | $198.90 | $198.90 | $234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.06 / $498.34 / $3,019.16
| Facility | | $188.06 | $498.34 | $3,019.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.35 / $342.70 / $699.11
| Professional | | $241.35 | $342.70 | $699.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.75 / $342.70 / $516.25
| Professional | | $242.75 | $342.70 | $516.25 |