- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.54 / $260.69 / $312.06
| Professional | | $203.54 | $260.69 | $312.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.94 / $114.94 / $114.94
| Professional | | $114.94 | $114.94 | $114.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.84 / $312.06 / $374.47
| Facility | | $169.84 | $312.06 | $374.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.32 / $311.45 / $327.85
| Professional | | $303.32 | $311.45 | $327.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.41 / $265.02 / $320.17
| Professional | | $234.41 | $265.02 | $320.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.93 / $312.06 / $374.47
| Facility | | $227.93 | $312.06 | $374.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.94 / $234.41 / $374.16
| Professional | | $114.94 | $234.41 | $374.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.47 / $163.56 / $531.64
| Professional | | $119.47 | $163.56 | $531.64 |