- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $498.06
| Professional | | $318.52 | $318.52 | $498.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.47 / $555.47 / $555.47
| Facility | | $555.47 | $555.47 | $555.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.47 / $555.47 / $555.47
| Professional | | $555.47 | $555.47 | $555.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.88 / $477.88 / $645.71
| Facility | | $477.88 | $477.88 | $645.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.85 / $348.85 / $564.55
| Professional | | $348.85 | $348.85 | $564.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.48 / $283.76 / $315.04
| Professional | | $256.48 | $283.76 | $315.04 |