- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.90 / $347.80 / $1,579.08
| Professional | | $230.90 | $347.80 | $1,579.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.39 / $1,430.81 / $2,211.75
| Facility | | $510.39 | $1,430.81 | $2,211.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.02 / $324.02 / $381.95
| Professional | | $324.02 | $324.02 | $381.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.63 / $203.63 / $537.50
| Facility | | $203.63 | $203.63 | $537.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.85 / $318.43 / $461.27
| Professional | | $133.85 | $318.43 | $461.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.63 / $203.63 / $537.50
| Facility | | $203.63 | $203.63 | $537.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.87 / $308.08 / $461.27
| Professional | | $155.87 | $308.08 | $461.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.44 / $254.32 / $528.46
| Professional | | $139.44 | $254.32 | $528.46 |