- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.48 / $567.35 / $2,156.48
| Professional | | $319.48 | $567.35 | $2,156.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.35 / $561.35 / $561.35
| Facility | | $561.35 | $561.35 | $561.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $628.41 / $690.30 / $837.63
| Professional | | $628.41 | $690.30 | $837.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.35 / $561.35 / $561.35
| Facility | | $561.35 | $561.35 | $561.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.13 / $690.30 / $837.63
| Professional | | $269.13 | $690.30 | $837.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.49 / $457.54 / $774.86
| Professional | | $146.49 | $457.54 | $774.86 |