- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.93 / $341.64 / $341.64
| Professional | | $245.93 | $341.64 | $341.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.61 / $648.58 / $1,202.27
| Facility | | $500.61 | $648.58 | $1,202.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.66 / $325.54 / $325.54
| Professional | | $307.66 | $325.54 | $325.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.45 / $361.45 / $413.70
| Facility | | $361.45 | $361.45 | $413.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.86 / $263.86 / $361.45
| Professional | | $263.86 | $263.86 | $361.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.72 / $455.72 / $455.72
| Professional | | $455.72 | $455.72 | $455.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.38 / $341.63 / $341.64
| Professional | | $306.38 | $341.63 | $341.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.09 / $280.80 / $645.76
| Professional | | $196.09 | $280.80 | $645.76 |