- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.51 / $188.51 / $294.76
| Professional | | $188.51 | $188.51 | $294.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.73 / $328.73 / $328.73
| Facility | | $328.73 | $328.73 | $328.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.73 / $328.73 / $328.73
| Professional | | $328.73 | $328.73 | $328.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.16 / $214.16 / $343.13
| Facility | | $214.16 | $214.16 | $343.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.34 / $156.34 / $214.16
| Professional | | $156.34 | $156.34 | $214.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.63 / $154.24 / $154.24
| Facility | | $119.63 | $154.24 | $154.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.49 / $155.62 / $172.77
| Professional | | $146.49 | $155.62 | $172.77 |