- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $436.52
| Professional | | $251.19 | $331.13 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $467.74 / $512.86
| Professional | | $457.09 | $467.74 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $436.52
| Facility | | $331.13 | $331.13 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $331.13 / $407.38
| Professional | | $281.84 | $331.13 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.30 / $194.98 / $354.81
| Facility | | $26.30 | $194.98 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $275.42 / $562.34
| Professional | | $169.82 | $275.42 | $562.34 |