- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.48 / $363.06 / $442.97
| Professional | | $318.48 | $363.06 | $442.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.69 / $362.69 / $436.46
| Professional | | $362.69 | $362.69 | $436.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.52 / $289.52 / $289.52
| Professional | | $289.52 | $289.52 | $289.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.48 / $363.06 / $435.67
| Facility | | $318.48 | $363.06 | $435.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.13 / $325.13 / $325.13
| Professional | | $325.13 | $325.13 | $325.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $55.00
| Professional | | $30.00 | $30.00 | $55.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.85 / $347.56 / $529.62
| Professional | | $281.85 | $347.56 | $529.62 |