- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.23 / $378.88 / $471.17
| Professional | | $328.23 | $378.88 | $471.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.34 / $220.34 / $220.34
| Professional | | $220.34 | $220.34 | $220.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.28 / $112.28 / $112.28
| Facility | | $112.28 | $112.28 | $112.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.35 / $59.35 / $59.35
| Professional | | $59.35 | $59.35 | $59.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $468.96
| Facility | | $330.77 | $330.77 | $468.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.97 / $330.77 / $388.74
| Professional | | $35.97 | $330.77 | $388.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.59 / $280.47 / $534.75
| Professional | | $166.59 | $280.47 | $534.75 |