- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.04 / $799.72 / $1,036.58
| Professional | | $461.04 | $799.72 | $1,036.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $844.34 / $844.34 / $844.34
| Professional | | $844.34 | $844.34 | $844.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.55 / $172.55 / $172.55
| Facility | | $172.55 | $172.55 | $172.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.36 / $101.36 / $101.36
| Professional | | $101.36 | $101.36 | $101.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.37 / $867.37 / $1,301.14
| Facility | | $867.37 | $867.37 | $1,301.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.85 / $867.37 / $867.37
| Professional | | $103.85 | $867.37 | $867.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.16 / $660.24 / $1,339.34
| Professional | | $440.16 | $660.24 | $1,339.34 |