- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $478.63 / $602.56
| Professional | | $371.54 | $478.63 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $1,513.56
| Professional | | $537.03 | $537.03 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $812.83 / $1,548.82
| Professional | | $467.74 | $812.83 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $1,513.56
| Professional | | $436.52 | $436.52 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $741.31 / $1,202.26
| Professional | | $389.05 | $741.31 | $1,202.26 |