- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.40 / $254.87 / $382.92
| Professional | | $213.40 | $254.87 | $382.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.83 / $1,044.83 / $1,044.83
| Facility | | $1,044.83 | $1,044.83 | $1,044.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.52 / $333.52 / $366.87
| Professional | | $333.52 | $333.52 | $366.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $213.23 / $213.23
| Professional | | $213.23 | $213.23 | $213.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.25 / $362.25 / $362.25
| Professional | | $362.25 | $362.25 | $362.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.40 / $254.87 / $382.92
| Professional | | $213.40 | $254.87 | $382.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.53 / $221.62 / $509.66
| Professional | | $173.53 | $221.62 | $509.66 |