- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.62 / $277.62 / $320.33
| Professional | | $277.62 | $277.62 | $320.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.63 / $142.63 / $154.10
| Facility | | $142.63 | $142.63 | $154.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.27 / $460.27 / $460.27
| Professional | | $460.27 | $460.27 | $460.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.37 / $325.37 / $325.37
| Facility | | $325.37 | $325.37 | $325.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.52 / $438.88 / $467.69
| Professional | | $237.52 | $438.88 | $467.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.37 / $325.37 / $325.37
| Facility | | $325.37 | $325.37 | $325.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.52 / $439.26 / $467.69
| Professional | | $237.52 | $439.26 | $467.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.21 / $337.00 / $657.67
| Professional | | $189.21 | $337.00 | $657.67 |