- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.12 / $387.63 / $1,025.55
| Professional | | $282.12 | $387.63 | $1,025.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.94 / $383.04 / $437.82
| Professional | | $319.94 | $383.04 | $437.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.97 / $171.97 / $171.97
| Facility | | $171.97 | $171.97 | $171.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.98 / $477.22 / $927.22
| Professional | | $299.98 | $477.22 | $927.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.18 / $540.63 / $918.91
| Professional | | $415.18 | $540.63 | $918.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.87 / $476.57 / $963.03
| Professional | | $335.87 | $476.57 | $963.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.67 / $481.95 / $585.24
| Professional | | $382.67 | $481.95 | $585.24 |