- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.64 / $247.64 / $285.74
| Professional | | $247.64 | $247.64 | $285.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.26 / $366.26 / $372.99
| Facility | | $366.26 | $366.26 | $372.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.37 / $345.63 / $390.45
| Professional | | $267.37 | $345.63 | $390.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.26 / $366.26 / $372.99
| Facility | | $366.26 | $366.26 | $372.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.37 / $366.26 / $390.45
| Professional | | $267.37 | $366.26 | $390.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.78 / $328.04 / $586.66
| Professional | | $168.78 | $328.04 | $586.66 |