- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.67 / $264.67 / $305.39
| Professional | | $264.67 | $264.67 | $305.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.80 / $438.80 / $438.80
| Professional | | $438.80 | $438.80 | $438.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.54 / $274.54 / $398.64
| Facility | | $274.54 | $274.54 | $398.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.41 / $200.41 / $270.98
| Professional | | $200.41 | $200.41 | $270.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.54 / $274.54 / $398.64
| Facility | | $274.54 | $274.54 | $398.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.41 / $200.41 / $270.98
| Professional | | $200.41 | $200.41 | $270.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.39 / $327.07 / $627.02
| Professional | | $180.39 | $327.07 | $627.02 |