- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $316.23 / $467.74
| Professional | | $275.42 | $316.23 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $446.68 / $691.83
| Professional | | $288.40 | $446.68 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $691.83
| Facility | | $512.86 | $512.86 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $407.38 / $741.31
| Professional | | $251.19 | $407.38 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $524.81 / $912.01
| Professional | | $354.81 | $524.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $323.59 / $457.09
| Professional | | $275.42 | $323.59 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $691.83
| Professional | | $295.12 | $426.58 | $691.83 |