- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $263.03 / $323.59
| Professional | | $234.42 | $263.03 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $5,248.07
| Facility | | $691.83 | $691.83 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $549.54 / $549.54
| Professional | | $467.74 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $309.03 / $549.54
| Facility | | $251.19 | $309.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $269.15 / $323.59
| Professional | | $245.47 | $269.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $77.62
| Professional | | $30.20 | $30.20 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $851.14 / $8,317.64
| Professional | | $371.54 | $851.14 | $8,317.64 |