- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.13 / $389.61 / $1,849.42
| Professional | | $278.13 | $389.61 | $1,849.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.41 / $548.41 / $548.41
| Facility | | $548.41 | $548.41 | $548.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.15 / $575.60 / $803.42
| Professional | | $466.15 | $575.60 | $803.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $493.53 / $789.65
| Facility | | $307.55 | $493.53 | $789.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.20 / $609.44 / $961.40
| Professional | | $433.20 | $609.44 | $961.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.37 / $843.31 / $921.54
| Professional | | $683.37 | $843.31 | $921.54 |