- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $660.69 / $954.99
| Professional | | $436.52 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Facility | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,344.23 / $2,398.83
| Professional | | $1,995.26 | $2,344.23 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $380.19 / $575.44
| Facility | | $51.29 | $380.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $436.52 / $741.31
| Professional | | $295.12 | $436.52 | $741.31 |