- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.21 / $402.48 / $2,087.05
| Professional | | $227.21 | $402.48 | $2,087.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.09 / $423.09 / $423.09
| Facility | | $423.09 | $423.09 | $423.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.60 / $445.60 / $543.27
| Facility | | $445.60 | $445.60 | $543.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.66 / $367.76 / $728.97
| Professional | | $154.66 | $367.76 | $728.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.60 / $445.60 / $543.27
| Facility | | $445.60 | $445.60 | $543.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.66 / $367.76 / $728.97
| Professional | | $154.66 | $367.76 | $728.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.78 / $330.01 / $1,460.61
| Professional | | $141.78 | $330.01 | $1,460.61 |