- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.12 / $282.61 / $330.74
| Professional | | $239.12 | $282.61 | $330.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,034.75 / $2,670.43 / $3,085.73
| Facility | | $1,034.75 | $2,670.43 | $3,085.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.43 / $292.43 / $628.35
| Professional | | $292.43 | $292.43 | $628.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.48 / $3,298.10 / $5,797.86
| Facility | | $1,200.48 | $3,298.10 | $5,797.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.61 / $568.14 / $697.25
| Professional | | $304.61 | $568.14 | $697.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.27 / $284.75 / $526.17
| Professional | | $183.27 | $284.75 | $526.17 |