- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.95 / $900.92 / $900.92
| Professional | | $375.95 | $900.92 | $900.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $499.17 / $499.17 / $598.42
| Facility | | $499.17 | $499.17 | $598.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.39 / $499.17 / $514.15
| Professional | | $364.39 | $499.17 | $514.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.53 / $724.74 / $1,028.86
| Facility | | $248.53 | $724.74 | $1,028.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.98 / $977.43 / $1,028.86
| Professional | | $925.98 | $977.43 | $1,028.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $759.30 / $904.28
| Professional | | $30.00 | $759.30 | $904.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.92 / $1,004.76 / $1,507.14
| Facility | | $900.92 | $1,004.76 | $1,507.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.21 / $720.21 / $1,080.31
| Professional | | $720.21 | $720.21 | $1,080.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.93 / $384.97 / $1,288.43
| Professional | | $355.93 | $384.97 | $1,288.43 |