- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.50 / $310.50 / $358.27
| Professional | | $310.50 | $310.50 | $358.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.78 / $514.78 / $514.78
| Professional | | $514.78 | $514.78 | $514.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.79 / $313.79 / $467.67
| Facility | | $313.79 | $313.79 | $467.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.07 / $313.79 / $334.52
| Professional | | $229.07 | $313.79 | $334.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.79 / $313.79 / $467.67
| Facility | | $313.79 | $313.79 | $467.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.07 / $313.79 / $334.52
| Professional | | $229.07 | $313.79 | $334.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.08 / $376.92 / $735.57
| Professional | | $220.08 | $376.92 | $735.57 |