- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.14 / $263.05 / $350.74
| Professional | | $188.14 | $263.05 | $350.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Facility | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.42 / $261.42 / $353.87
| Professional | | $261.42 | $261.42 | $353.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.67 / $311.67 / $311.67
| Facility | | $311.67 | $311.67 | $311.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.41 / $314.22 / $500.68
| Professional | | $300.41 | $314.22 | $500.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.25 / $297.37 / $330.42
| Professional | | $198.25 | $297.37 | $330.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.94 / $244.58 / $304.61
| Professional | | $171.94 | $244.58 | $304.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.60 / $368.60 / $368.60
| Professional | | $368.60 | $368.60 | $368.60 |