- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $407.38
| Professional | | $251.19 | $331.13 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $17.78 / $26.92
| Facility | | $16.22 | $17.78 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $977.24
| Professional | | $354.81 | $446.68 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $354.81 / $616.60
| Professional | | $302.00 | $354.81 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $398.11 / $2,570.40
| Facility | | $218.78 | $398.11 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $489.78
| Professional | | $218.78 | $316.23 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $218.78 / $407.38
| Facility | | $25.70 | $218.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $489.78
| Professional | | $234.42 | $309.03 | $489.78 |