- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.85 / $419.60 / $441.07
| Professional | | $350.85 | $419.60 | $441.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.94 / $430.75 / $430.75
| Professional | | $401.94 | $430.75 | $430.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.55 / $354.55 / $465.35
| Facility | | $354.55 | $354.55 | $465.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.37 / $354.55 / $465.35
| Professional | | $301.37 | $354.55 | $465.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.35 / $329.79 / $466.78
| Professional | | $299.35 | $329.79 | $466.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.23 / $438.23 / $438.23
| Professional | | $438.23 | $438.23 | $438.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.49 / $320.75 / $491.50
| Professional | | $256.49 | $320.75 | $491.50 |