- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.39 / $488.39 / $563.53
| Professional | | $488.39 | $488.39 | $563.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.57 / $485.57 / $735.60
| Facility | | $485.57 | $485.57 | $735.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.47 / $485.57 / $517.64
| Professional | | $354.47 | $485.57 | $517.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.57 / $485.57 / $735.60
| Facility | | $485.57 | $485.57 | $735.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.47 / $485.57 / $517.64
| Professional | | $354.47 | $485.57 | $517.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.47 / $752.13 / $1,157.01
| Professional | | $374.47 | $752.13 | $1,157.01 |