- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.66 / $408.59 / $1,555.42
| Professional | | $230.66 | $408.59 | $1,555.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.79 / $502.79 / $512.70
| Facility | | $502.79 | $502.79 | $512.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.89 / $404.89 / $538.78
| Facility | | $404.89 | $404.89 | $538.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.76 / $453.08 / $604.10
| Professional | | $157.76 | $453.08 | $604.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.89 / $404.89 / $538.78
| Facility | | $404.89 | $404.89 | $538.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.76 / $375.10 / $604.10
| Professional | | $157.76 | $375.10 | $604.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.66 / $330.01 / $1,088.55
| Professional | | $105.66 | $330.01 | $1,088.55 |