- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.81 / $194.81 / $224.78
| Professional | | $194.81 | $194.81 | $224.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.97 / $322.97 / $322.97
| Professional | | $322.97 | $322.97 | $322.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.98 / $232.98 / $293.41
| Facility | | $232.98 | $232.98 | $293.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.08 / $232.98 / $273.20
| Professional | | $170.08 | $232.98 | $273.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.98 / $232.98 / $293.41
| Facility | | $232.98 | $232.98 | $293.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.08 / $232.98 / $273.20
| Professional | | $170.08 | $232.98 | $273.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.98 / $300.01 / $461.51
| Professional | | $172.98 | $300.01 | $461.51 |