- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.05 / $533.20 / $629.70
| Professional | | $383.05 | $533.20 | $629.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.59 / $359.59 / $359.59
| Facility | | $359.59 | $359.59 | $359.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.64 / $359.59 / $370.38
| Professional | | $305.64 | $359.59 | $370.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.85 / $450.98 / $644.25
| Facility | | $325.85 | $450.98 | $644.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.22 / $745.24 / $814.22
| Professional | | $509.22 | $745.24 | $814.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.41 / $675.21 / $844.02
| Professional | | $506.41 | $675.21 | $844.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.13 / $507.30 / $806.94
| Professional | | $417.13 | $507.30 | $806.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.51 / $911.51 / $911.51
| Professional | | $911.51 | $911.51 | $911.51 |