- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.49 / $278.68 / $502.63
| Professional | | $224.49 | $278.68 | $502.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.09 / $376.09 / $376.09
| Facility | | $376.09 | $376.09 | $376.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.68 / $376.09 / $661.50
| Professional | | $319.68 | $376.09 | $661.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.47 / $488.47 / $669.54
| Professional | | $488.47 | $488.47 | $669.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.45 / $381.45 / $381.45
| Professional | | $381.45 | $381.45 | $381.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.39 / $333.77 / $612.98
| Professional | | $270.39 | $333.77 | $612.98 |