- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.48 / $324.24 / $1,716.41
| Professional | | $257.48 | $324.24 | $1,716.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.11 / $532.11 / $532.11
| Facility | | $532.11 | $532.11 | $532.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.63 / $532.11 / $889.66
| Professional | | $306.63 | $532.11 | $889.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.82 / $430.60 / $581.27
| Facility | | $328.82 | $430.60 | $581.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.99 / $535.42 / $892.21
| Professional | | $327.99 | $535.42 | $892.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.43 / $536.25 / $780.63
| Professional | | $447.43 | $536.25 | $780.63 |