- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.69 / $614.44 / $755.69
| Professional | | $529.69 | $614.44 | $755.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.81 / $882.81 / $882.81
| Professional | | $882.81 | $882.81 | $882.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.00 / $705.55 / $950.13
| Facility | | $565.00 | $705.55 | $950.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.81 / $423.75 / $3,517.13
| Professional | | $317.81 | $423.75 | $3,517.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.81 / $423.75 / $1,059.38
| Professional | | $317.81 | $423.75 | $1,059.38 |