- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $645.65
| Professional | | $331.13 | $549.54 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $1,737.80
| Professional | | $831.76 | $1,258.93 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $776.25 / $1,479.11
| Professional | | $457.09 | $776.25 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,630.27 / $10,471.29
| Facility | | $1,380.38 | $2,630.27 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $758.58 / $1,819.70
| Professional | | $407.38 | $758.58 | $1,819.70 |