- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.64 / $205.63 / $293.61
| Professional | | $174.64 | $205.63 | $293.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.10 / $361.22 / $361.22
| Professional | | $325.10 | $361.22 | $361.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.22 / $361.22 / $361.22
| Facility | | $361.22 | $361.22 | $361.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.63 / $326.39 / $497.02
| Professional | | $225.63 | $326.39 | $497.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.98 / $276.74 / $485.13
| Facility | | $167.98 | $276.74 | $485.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.79 / $396.27 / $617.27
| Professional | | $240.79 | $396.27 | $617.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.04 / $396.36 / $451.83
| Professional | | $310.04 | $396.36 | $451.83 |