- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.60 / $246.38 / $284.27
| Professional | | $125.60 | $246.38 | $284.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.47 / $408.47 / $408.47
| Professional | | $408.47 | $408.47 | $408.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $296.00 / $371.07
| Facility | | $296.00 | $296.00 | $371.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.08 / $296.00 / $315.55
| Professional | | $216.08 | $296.00 | $315.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $296.00 / $371.07
| Facility | | $296.00 | $296.00 | $371.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.08 / $296.00 / $315.55
| Professional | | $216.08 | $296.00 | $315.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.80 / $379.42 / $419.79
| Professional | | $183.80 | $379.42 | $419.79 |