- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.16 / $548.78 / $1,075.96
| Facility | | $286.16 | $548.78 | $1,075.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $753.37 / $1,228.45
| Facility | | $750.00 | $753.37 | $1,228.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.36 / $417.81 / $437.10
| Professional | | $318.36 | $417.81 | $437.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.64 / $428.13 / $555.65
| Facility | | $302.64 | $428.13 | $555.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.22 / $418.49 / $1,183.35
| Facility | | $291.22 | $418.49 | $1,183.35 |