- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.07 / $452.92 / $617.02
| Professional | | $315.07 | $452.92 | $617.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.89 / $199.89 / $473.97
| Professional | | $199.89 | $199.89 | $473.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.88 / $450.88 / $450.88
| Facility | | $450.88 | $450.88 | $450.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.34 / $450.88 / $464.41
| Professional | | $58.34 | $450.88 | $464.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.21 / $415.49 / $3,564.78
| Facility | | $57.21 | $415.49 | $3,564.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.45 / $354.97 / $724.70
| Professional | | $235.45 | $354.97 | $724.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.57 / $286.70 / $533.36
| Facility | | $36.57 | $286.70 | $533.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.99 / $345.30 / $679.81
| Professional | | $258.99 | $345.30 | $679.81 |