- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.33 / $384.51 / $531.67
| Professional | | $296.33 | $384.51 | $531.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.33 / $1,576.33 / $1,576.33
| Facility | | $1,576.33 | $1,576.33 | $1,576.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.19 / $783.55 / $783.55
| Professional | | $765.19 | $783.55 | $783.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.08 / $282.08 / $282.08
| Professional | | $282.08 | $282.08 | $282.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.52 / $546.52 / $546.52
| Professional | | $546.52 | $546.52 | $546.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.33 / $384.51 / $531.67
| Professional | | $296.33 | $384.51 | $531.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.80 / $334.36 / $768.92
| Professional | | $261.80 | $334.36 | $768.92 |