- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.18 / $315.94 / $338.07
| Professional | | $254.18 | $315.94 | $338.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.73 / $686.57 / $860.13
| Professional | | $349.73 | $686.57 | $860.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.65 / $487.65 / $487.65
| Facility | | $487.65 | $487.65 | $487.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.63 / $359.63 / $359.63
| Professional | | $359.63 | $359.63 | $359.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.18 / $315.94 / $338.07
| Professional | | $254.18 | $315.94 | $338.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.20 / $282.95 / $601.89
| Professional | | $189.20 | $282.95 | $601.89 |