- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.56 / $346.72 / $382.92
| Professional | | $274.56 | $346.72 | $382.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.16 / $403.16 / $403.16
| Professional | | $403.16 | $403.16 | $403.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $213.23 / $213.23
| Professional | | $213.23 | $213.23 | $213.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.39 / $346.72 / $529.38
| Facility | | $310.39 | $346.72 | $529.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.75 / $221.62 / $466.10
| Professional | | $147.75 | $221.62 | $466.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.75 / $207.60 / $317.95
| Professional | | $147.75 | $207.60 | $317.95 |