- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.38 / $306.38 / $1,962.46
| Professional | | $306.38 | $306.38 | $1,962.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.18 / $498.18 / $498.18
| Professional | | $498.18 | $498.18 | $498.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.45 / $535.64 / $535.64
| Facility | | $361.45 | $535.64 | $535.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.45 / $435.59 / $535.64
| Professional | | $361.45 | $435.59 | $535.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.42 / $510.13 / $535.64
| Facility | | $284.42 | $510.13 | $535.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.45 / $402.02 / $536.03
| Professional | | $361.45 | $402.02 | $536.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.02 / $254.50 / $389.46
| Professional | | $230.02 | $254.50 | $389.46 |