- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.84 / $407.84 / $407.84
| Professional | | $407.84 | $407.84 | $407.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.45 / $277.45 / $277.45
| Facility | | $277.45 | $277.45 | $277.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.54 / $277.45 / $285.77
| Professional | | $202.54 | $277.45 | $285.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.33 / $277.33 / $277.33
| Facility | | $277.33 | $277.33 | $277.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.72 / $442.46 / $698.63
| Professional | | $359.72 | $442.46 | $698.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.57 / $331.57 / $454.83
| Facility | | $331.57 | $331.57 | $454.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.57 / $454.83 / $937.95
| Professional | | $331.57 | $454.83 | $937.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.33 / $277.33 / $277.45
| Facility | | $277.33 | $277.33 | $277.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.45 / $360.41 / $545.79
| Professional | | $277.45 | $360.41 | $545.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $232.36 / $445.35
| Professional | | $225.11 | $232.36 | $445.35 |