- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.75 / $328.83 / $447.97
| Professional | | $228.75 | $328.83 | $447.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.00 / $351.47 / $368.60
| Professional | | $267.00 | $351.47 | $368.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Facility | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.42 / $261.42 / $353.87
| Professional | | $261.42 | $261.42 | $353.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.07 / $376.28 / $2,352.03
| Facility | | $137.07 | $376.28 | $2,352.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.91 / $249.79 / $509.57
| Professional | | $175.91 | $249.79 | $509.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.94 / $249.79 / $406.13
| Professional | | $176.94 | $249.79 | $406.13 |