- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.71 / $339.51 / $410.16
| Professional | | $208.71 | $339.51 | $410.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.74 / $369.97 / $399.33
| Professional | | $348.74 | $369.97 | $399.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.87 / $310.87 / $506.62
| Facility | | $310.87 | $310.87 | $506.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.24 / $310.87 / $481.92
| Professional | | $264.24 | $310.87 | $481.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.71 / $272.45 / $410.16
| Professional | | $208.71 | $272.45 | $410.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.30 / $323.82 / $661.11
| Professional | | $165.30 | $323.82 | $661.11 |