- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $870.96
| Professional | | $245.47 | $331.13 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $1,318.26
| Facility | | $812.83 | $1,122.02 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $371.54 / $602.56
| Professional | | $275.42 | $371.54 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $363.08
| Facility | | $323.59 | $323.59 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $363.08
| Professional | | $263.03 | $263.03 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $691.83
| Facility | | $251.19 | $316.23 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $467.74
| Professional | | $251.19 | $316.23 | $467.74 |