- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.60 / $334.31 / $455.43
| Professional | | $218.60 | $334.31 | $455.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.77 / $392.98 / $457.97
| Professional | | $335.77 | $392.98 | $457.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.62 / $327.62 / $327.62
| Facility | | $327.62 | $327.62 | $327.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.42 / $327.62 / $337.45
| Professional | | $42.42 | $327.62 | $337.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.20 / $369.29 / $1,856.74
| Facility | | $62.20 | $369.29 | $1,856.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.66 / $264.64 / $516.57
| Professional | | $194.66 | $264.64 | $516.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.45 / $253.57 / $471.63
| Professional | | $211.45 | $253.57 | $471.63 |