- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.12 / $427.66 / $427.66
| Professional | | $394.12 | $427.66 | $427.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,941.62 / $2,670.43 / $3,085.73
| Facility | | $1,941.62 | $2,670.43 | $3,085.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.79 / $478.79 / $795.05
| Professional | | $478.79 | $478.79 | $795.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,956.39 / $3,298.10 / $5,797.86
| Facility | | $1,956.39 | $3,298.10 | $5,797.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.73 / $894.50 / $936.13
| Professional | | $498.73 | $894.50 | $936.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.87 / $367.97 / $775.17
| Professional | | $215.87 | $367.97 | $775.17 |