- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $202.99 / $202.99
| Professional | | $158.49 | $202.99 | $202.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.04 / $319.85 / $406.32
| Professional | | $301.04 | $319.85 | $406.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.61 / $482.61 / $482.61
| Facility | | $482.61 | $482.61 | $482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.22 / $437.79 / $482.61
| Professional | | $410.22 | $437.79 | $482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.88 / $199.88 / $199.88
| Professional | | $199.88 | $199.88 | $199.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.99 / $202.99 / $304.74
| Professional | | $202.99 | $202.99 | $304.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.24 / $199.88 / $385.24
| Professional | | $100.24 | $199.88 | $385.24 |