- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.74 / $306.64 / $453.43
| Professional | | $184.74 | $306.64 | $453.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.22 / $266.42 / $361.13
| Professional | | $230.22 | $266.42 | $361.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.64 / $531.64 / $531.64
| Facility | | $531.64 | $531.64 | $531.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.49 / $421.36 / $582.65
| Professional | | $318.49 | $421.36 | $582.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.33 / $345.42 / $537.47
| Professional | | $254.33 | $345.42 | $537.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.74 / $273.89 / $432.10
| Professional | | $184.74 | $273.89 | $432.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.22 / $395.74 / $514.16
| Professional | | $274.22 | $395.74 | $514.16 |