- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.66 / $408.59 / $2,118.75
| Professional | | $230.66 | $408.59 | $2,118.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.51 / $551.51 / $551.51
| Facility | | $551.51 | $551.51 | $551.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.90 / $373.06 / $740.33
| Professional | | $156.90 | $373.06 | $740.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.51 / $551.51 / $551.51
| Facility | | $551.51 | $551.51 | $551.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.90 / $373.06 / $740.33
| Professional | | $156.90 | $373.06 | $740.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.93 / $330.01 / $1,482.80
| Professional | | $143.93 | $330.01 | $1,482.80 |