- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.20 / $229.01 / $306.70
| Professional | | $178.20 | $229.01 | $306.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.64 / $363.64 / $363.64
| Professional | | $363.64 | $363.64 | $363.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.51 / $277.51 / $371.51
| Facility | | $277.51 | $277.51 | $371.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.88 / $277.51 / $371.51
| Professional | | $235.88 | $277.51 | $371.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.51 / $277.51 / $371.51
| Facility | | $277.51 | $277.51 | $371.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.51 / $277.51 / $371.51
| Professional | | $277.51 | $277.51 | $371.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.40 / $361.86 / $474.94
| Professional | | $148.40 | $361.86 | $474.94 |