- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.96 / $521.41 / $704.85
| Professional | | $352.96 | $521.41 | $704.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.94 / $472.94 / $472.94
| Professional | | $472.94 | $472.94 | $472.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $396.27
| Facility | | $330.77 | $330.77 | $396.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.14 / $330.77 / $396.27
| Professional | | $281.14 | $330.77 | $396.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $396.27
| Facility | | $330.77 | $330.77 | $396.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.77 / $330.77 / $396.27
| Professional | | $330.77 | $330.77 | $396.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.92 / $419.81 / $468.70
| Professional | | $167.92 | $419.81 | $468.70 |