- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.97 / $352.81 / $592.78
| Professional | | $264.97 | $352.81 | $592.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.00 / $359.00 / $457.29
| Professional | | $359.00 | $359.00 | $457.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $459.90 / $459.90 / $459.90
| Facility | | $459.90 | $459.90 | $459.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.73 / $335.73 / $335.73
| Professional | | $335.73 | $335.73 | $335.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.27 / $668.95 / $963.29
| Professional | | $468.27 | $668.95 | $963.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.35 / $345.22 / $529.22
| Professional | | $301.35 | $345.22 | $529.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.96 / $366.96 / $468.27
| Professional | | $366.96 | $366.96 | $468.27 |