- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.18 / $314.16 / $1,727.51
| Professional | | $207.18 | $314.16 | $1,727.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.95 / $304.95 / $304.95
| Facility | | $304.95 | $304.95 | $304.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.95 / $328.25 / $552.62
| Professional | | $304.95 | $328.25 | $552.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.52 / $519.35 / $540.16
| Facility | | $189.52 | $519.35 | $540.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.38 / $369.78 / $568.86
| Professional | | $198.38 | $369.78 | $568.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.69 / $546.92 / $971.26
| Professional | | $435.69 | $546.92 | $971.26 |