- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.24 / $277.57 / $346.96
| Professional | | $177.24 | $277.57 | $346.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.47 / $46.26 / $46.26
| Professional | | $34.47 | $46.26 | $46.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.16 / $347.16 / $514.13
| Facility | | $347.16 | $347.16 | $514.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.08 / $347.16 / $641.25
| Professional | | $295.08 | $347.16 | $641.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.32 / $364.31 / $2,490.09
| Facility | | $166.32 | $364.31 | $2,490.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.60 / $276.62 / $400.43
| Professional | | $168.60 | $276.62 | $400.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.75 / $275.80 / $389.16
| Professional | | $210.75 | $275.80 | $389.16 |