- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.95 / $525.74 / $692.22
| Professional | | $509.95 | $525.74 | $692.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.17 / $2,228.78 / $2,638.61
| Facility | | $1,650.17 | $2,228.78 | $2,638.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.17 / $657.17 / $1,055.46
| Professional | | $657.17 | $657.17 | $1,055.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.94 / $612.94 / $675.10
| Facility | | $612.94 | $612.94 | $675.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.45 / $612.94 / $612.94
| Professional | | $447.45 | $612.94 | $612.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $577.08 / $577.08 / $577.08
| Facility | | $577.08 | $577.08 | $577.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.92 / $656.26 / $970.45
| Professional | | $455.92 | $656.26 | $970.45 |