- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.05 / $273.45 / $384.75
| Professional | | $239.05 | $273.45 | $384.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.22 / $410.45 / $486.17
| Professional | | $336.22 | $410.45 | $486.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.16 / $342.58 / $407.55
| Facility | | $244.16 | $342.58 | $407.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.94 / $430.85 / $487.14
| Professional | | $394.94 | $430.85 | $487.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $355.96 / $447.82
| Professional | | $32.34 | $355.96 | $447.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.93 / $375.12 / $444.07
| Professional | | $312.93 | $375.12 | $444.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.20 / $366.50 / $498.45
| Professional | | $271.20 | $366.50 | $498.45 |