- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $575.44 / $724.44
| Professional | | $338.84 | $575.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $776.25 / $1,548.82
| Professional | | $75.86 | $776.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $446.68 / $4,897.79
| Facility | | $89.13 | $446.68 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $660.69
| Professional | | $309.03 | $467.74 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $316.23 / $741.31
| Facility | | $42.66 | $316.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $467.74 / $660.69
| Professional | | $338.84 | $467.74 | $660.69 |