- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.43 / $397.74 / $406.60
| Professional | | $300.43 | $397.74 | $406.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.27 / $375.58 / $375.58
| Professional | | $296.27 | $375.58 | $375.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.77 / $172.77 / $172.77
| Facility | | $172.77 | $172.77 | $172.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.85 / $172.77 / $172.77
| Professional | | $146.85 | $172.77 | $172.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.11 / $292.11 / $292.11
| Professional | | $292.11 | $292.11 | $292.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.94 / $239.08 / $316.27
| Professional | | $162.94 | $239.08 | $316.27 |