- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.86 / $223.86 / $258.30
| Professional | | $223.86 | $223.86 | $258.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.14 / $371.14 / $371.14
| Professional | | $371.14 | $371.14 | $371.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.27 / $294.27 / $337.16
| Facility | | $294.27 | $294.27 | $337.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.82 / $261.37 / $313.72
| Professional | | $214.82 | $261.37 | $313.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.27 / $294.27 / $337.16
| Facility | | $294.27 | $294.27 | $337.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.82 / $294.27 / $313.72
| Professional | | $214.82 | $294.27 | $313.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.79 / $276.79 / $331.65
| Facility | | $276.79 | $276.79 | $331.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.57 / $315.60 / $530.32
| Professional | | $152.57 | $315.60 | $530.32 |