- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.18 / $491.49 / $540.51
| Professional | | $398.18 | $491.49 | $540.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.48 / $1,740.28 / $2,060.28
| Facility | | $1,288.48 | $1,740.28 | $2,060.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.96 / $595.25 / $824.13
| Professional | | $505.96 | $595.25 | $824.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.34 / $511.34 / $527.14
| Facility | | $511.34 | $511.34 | $527.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.28 / $511.34 / $511.34
| Professional | | $373.28 | $511.34 | $511.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.62 / $404.62 / $404.62
| Facility | | $404.62 | $404.62 | $404.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.99 / $454.65 / $757.75
| Professional | | $355.99 | $454.65 | $757.75 |