- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.97 / $326.75 / $326.75
| Professional | | $211.97 | $326.75 | $326.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.49 / $559.04 / $1,036.28
| Facility | | $431.49 | $559.04 | $1,036.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.35 / $283.35 / $364.22
| Professional | | $283.35 | $283.35 | $364.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.50 / $321.50 / $321.50
| Facility | | $321.50 | $321.50 | $321.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.70 / $234.70 / $321.50
| Professional | | $234.70 | $234.70 | $321.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.80 / $392.80 / $392.80
| Professional | | $392.80 | $392.80 | $392.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.17 / $326.75 / $326.75
| Professional | | $273.17 | $326.75 | $326.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.68 / $338.98 / $556.60
| Professional | | $170.68 | $338.98 | $556.60 |