- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.55 / $644.63 / $737.66
| Professional | | $499.55 | $644.63 | $737.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.01 / $961.75 / $1,298.18
| Facility | | $904.01 | $961.75 | $1,298.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.92 / $848.62 / $1,981.87
| Professional | | $719.92 | $848.62 | $1,981.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.04 / $878.87 / $1,216.82
| Professional | | $595.04 | $878.87 | $1,216.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.68 / $878.87 / $1,216.82
| Professional | | $684.68 | $878.87 | $1,216.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.55 / $764.27 / $2,221.80
| Professional | | $729.55 | $764.27 | $2,221.80 |