- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.49 / $479.62 / $593.72
| Professional | | $368.49 | $479.62 | $593.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.90 / $719.43 / $802.33
| Facility | | $688.90 | $719.43 | $802.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.68 / $438.68 / $980.37
| Professional | | $438.68 | $438.68 | $980.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.08 / $1,396.08 / $2,454.23
| Facility | | $1,396.08 | $1,396.08 | $2,454.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.12 / $671.95 / $1,242.33
| Professional | | $385.12 | $671.95 | $1,242.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.66 / $401.17 / $1,157.20
| Professional | | $245.66 | $401.17 | $1,157.20 |