- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $204.17 / $645.65
| Professional | | $173.78 | $204.17 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $501.19 / $575.44
| Facility | | $416.87 | $501.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $275.42
| Professional | | $204.17 | $204.17 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $309.03
| Facility | | $218.78 | $218.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $218.78
| Professional | | $158.49 | $158.49 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $446.68
| Professional | | $371.54 | $371.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $257.04 / $645.65
| Professional | | $173.78 | $257.04 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $165.96 / $169.82
| Facility | | $36.31 | $165.96 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $223.87 / $371.54
| Professional | | $141.25 | $223.87 | $371.54 |