- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.85 / $238.48 / $307.14
| Professional | | $154.85 | $238.48 | $307.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.61 / $328.61 / $328.61
| Professional | | $328.61 | $328.61 | $328.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.38 / $341.38 / $341.38
| Facility | | $341.38 | $341.38 | $341.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.38 / $341.38 / $341.38
| Professional | | $341.38 | $341.38 | $341.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.17 / $243.17 / $385.50
| Facility | | $243.17 | $243.17 | $385.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.69 / $243.17 / $319.16
| Professional | | $206.69 | $243.17 | $319.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.63 / $216.35 / $449.83
| Professional | | $123.63 | $216.35 | $449.83 |