- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.58 / $327.58 / $377.99
| Professional | | $327.58 | $327.58 | $377.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.30 / $324.30 / $493.39
| Facility | | $324.30 | $324.30 | $493.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.74 / $236.74 / $323.35
| Professional | | $236.74 | $236.74 | $323.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.30 / $324.30 / $493.39
| Facility | | $324.30 | $324.30 | $493.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.74 / $236.74 / $323.35
| Professional | | $236.74 | $236.74 | $323.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.27 / $397.66 / $776.05
| Professional | | $223.27 | $397.66 | $776.05 |