- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,047.13
| Professional | | $562.34 | $794.33 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Facility | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $660.69 / $676.08
| Professional | | $562.34 | $660.69 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $346.74 / $524.81
| Facility | | $30.20 | $346.74 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $436.52 / $831.76
| Professional | | $269.15 | $436.52 | $831.76 |