- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $436.52 / $1,380.38
| Professional | | $288.40 | $436.52 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,778.28 / $2,089.30
| Facility | | $1,288.25 | $1,778.28 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $954.99
| Professional | | $380.19 | $501.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $512.86 / $512.86
| Facility | | $416.87 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $416.87
| Professional | | $309.03 | $309.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $512.86 / $912.01
| Facility | | $446.68 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $478.63 / $741.31
| Professional | | $407.38 | $478.63 | $741.31 |