- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.33 / $390.09 / $390.09
| Professional | | $327.33 | $390.09 | $390.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,008.21 / $1,392.64 / $2,285.61
| Facility | | $1,008.21 | $1,392.64 | $2,285.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.10 / $396.59 / $588.79
| Professional | | $337.10 | $396.59 | $588.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.08 / $551.64 / $714.39
| Professional | | $391.08 | $551.64 | $714.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.45 / $432.08 / $810.69
| Professional | | $373.45 | $432.08 | $810.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.33 / $390.09 / $496.91
| Professional | | $327.33 | $390.09 | $496.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.73 / $472.47 / $633.69
| Professional | | $270.73 | $472.47 | $633.69 |