- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.53 / $248.30 / $392.56
| Professional | | $205.53 | $248.30 | $392.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.00 / $269.00 / $343.29
| Professional | | $269.00 | $269.00 | $343.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.79 / $313.79 / $313.79
| Facility | | $313.79 | $313.79 | $313.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.07 / $229.07 / $313.79
| Professional | | $229.07 | $229.07 | $313.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.53 / $502.18 / $723.14
| Professional | | $351.53 | $502.18 | $723.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.33 / $250.53 / $399.35
| Professional | | $212.33 | $250.53 | $399.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.85 / $300.85 / $351.53
| Professional | | $300.85 | $300.85 | $351.53 |