- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.90 / $352.96 / $660.23
| Professional | | $327.90 | $352.96 | $660.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.65 / $54.65 / $72.47
| Professional | | $54.65 | $54.65 | $72.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $396.27
| Facility | | $330.77 | $330.77 | $396.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.97 / $330.77 / $506.25
| Professional | | $35.97 | $330.77 | $506.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.59 / $344.30 / $2,028.80
| Facility | | $51.59 | $344.30 | $2,028.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.24 / $331.47 / $565.59
| Professional | | $208.24 | $331.47 | $565.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.24 / $279.38 / $565.59
| Professional | | $208.24 | $279.38 | $565.59 |