- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.22 / $408.43 / $408.43
| Professional | | $364.22 | $408.43 | $408.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.36 / $698.79 / $1,295.33
| Facility | | $539.36 | $698.79 | $1,295.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.58 / $386.99 / $455.28
| Professional | | $379.58 | $386.99 | $455.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.14 / $459.90 / $459.90
| Facility | | $425.14 | $459.90 | $459.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.73 / $335.73 / $459.90
| Professional | | $335.73 | $335.73 | $459.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.01 / $491.01 / $491.01
| Professional | | $491.01 | $491.01 | $491.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.46 / $408.43 / $408.43
| Professional | | $341.46 | $408.43 | $408.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.70 / $398.95 / $695.75
| Professional | | $201.70 | $398.95 | $695.75 |