- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.20 / $226.61 / $288.49
| Professional | | $169.20 | $226.61 | $288.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.54 / $312.54 / $312.54
| Professional | | $312.54 | $312.54 | $312.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.62 / $267.62 / $330.59
| Facility | | $267.62 | $267.62 | $330.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.48 / $267.62 / $330.59
| Professional | | $227.48 | $267.62 | $330.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.62 / $267.62 / $330.59
| Facility | | $267.62 | $267.62 | $330.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.62 / $267.62 / $330.59
| Professional | | $267.62 | $267.62 | $330.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.49 / $264.64 / $350.55
| Professional | | $127.49 | $264.64 | $350.55 |