- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.84 / $639.10 / $741.51
| Professional | | $519.84 | $639.10 | $741.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.14 / $81.34 / $81.34
| Professional | | $69.14 | $81.34 | $81.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.44 / $1,042.44 / $1,042.44
| Facility | | $1,042.44 | $1,042.44 | $1,042.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.07 / $886.07 / $886.07
| Professional | | $886.07 | $886.07 | $886.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.38 / $749.14 / $1,560.70
| Professional | | $460.38 | $749.14 | $1,560.70 |