- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.84 / $337.84 / $389.82
| Professional | | $337.84 | $337.84 | $389.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.60 / $432.60 / $508.84
| Facility | | $432.60 | $432.60 | $508.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.80 / $432.60 / $461.17
| Professional | | $315.80 | $432.60 | $461.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.60 / $432.60 / $508.84
| Facility | | $432.60 | $432.60 | $508.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.80 / $432.60 / $461.17
| Professional | | $315.80 | $432.60 | $461.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.41 / $456.41 / $456.41
| Facility | | $456.41 | $456.41 | $456.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.26 / $520.39 / $575.65
| Professional | | $230.26 | $520.39 | $575.65 |