- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.29 / $299.08 / $299.08
| Professional | | $215.29 | $299.08 | $299.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.24 / $567.78 / $1,052.49
| Facility | | $438.24 | $567.78 | $1,052.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.09 / $235.83 / $235.83
| Professional | | $225.09 | $235.83 | $235.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.92 / $230.92 / $362.16
| Facility | | $230.92 | $230.92 | $362.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.57 / $177.79 / $230.92
| Professional | | $168.57 | $177.79 | $230.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.95 / $398.95 / $398.95
| Professional | | $398.95 | $398.95 | $398.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.45 / $299.08 / $299.08
| Professional | | $277.45 | $299.08 | $299.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.88 / $245.83 / $565.33
| Professional | | $163.88 | $245.83 | $565.33 |