- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.69 / $436.72 / $545.90
| Professional | | $376.69 | $436.72 | $545.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $627.29 / $627.29
| Facility | | $294.00 | $627.29 | $627.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.00 / $510.70 / $893.86
| Professional | | $218.00 | $510.70 | $893.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.41 / $294.00 / $351.70
| Facility | | $213.41 | $294.00 | $351.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.41 / $319.20 / $387.77
| Professional | | $213.41 | $319.20 | $387.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.70 / $280.70 / $548.70
| Professional | | $280.70 | $280.70 | $548.70 |