- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.70 / $268.14 / $357.52
| Professional | | $191.70 | $268.14 | $357.52 |
- 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 / $177.95
| Professional | | $146.85 | $172.77 | $177.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.61 / $317.61 / $317.61
| Facility | | $317.61 | $317.61 | $317.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.04 / $365.14 / $429.86
| Professional | | $230.04 | $365.14 | $429.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.16 / $269.33 / $336.67
| Professional | | $185.16 | $269.33 | $336.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.07 / $214.81 / $310.37
| Professional | | $174.07 | $214.81 | $310.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.58 / $375.58 / $375.58
| Professional | | $375.58 | $375.58 | $375.58 |