- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.71 / $250.71 / $472.88
| Professional | | $250.71 | $250.71 | $472.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.64 / $407.64 / $407.64
| Professional | | $407.64 | $407.64 | $407.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.73 / $438.30 / $438.30
| Facility | | $315.73 | $438.30 | $438.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.73 / $356.43 / $438.30
| Professional | | $315.73 | $356.43 | $438.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.73 / $417.43 / $438.30
| Facility | | $232.73 | $417.43 | $438.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.73 / $328.96 / $451.34
| Professional | | $315.73 | $328.96 | $451.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.22 / $208.25 / $238.39
| Professional | | $188.22 | $208.25 | $238.39 |