- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.45 / $569.22 / $738.79
| Professional | | $320.45 | $569.22 | $738.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.54 / $815.54 / $815.54
| Facility | | $815.54 | $815.54 | $815.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.54 / $815.54 / $815.54
| Professional | | $815.54 | $815.54 | $815.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.42 / $581.42 / $927.26
| Facility | | $581.42 | $581.42 | $927.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.22 / $581.42 / $763.12
| Professional | | $494.22 | $581.42 | $763.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.08 / $470.69 / $960.63
| Professional | | $291.08 | $470.69 | $960.63 |