- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $455.19 / $460.95
| Professional | | $335.33 | $455.19 | $460.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,085.09 / $1,465.58 / $1,735.07
| Facility | | $1,085.09 | $1,465.58 | $1,735.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.33 / $403.33 / $674.54
| Professional | | $403.33 | $403.33 | $674.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.20 / $572.20 / $4,439.92
| Facility | | $572.20 | $572.20 | $4,439.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.71 / $572.20 / $572.20
| Professional | | $417.71 | $572.20 | $572.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.06 / $485.80 / $638.14
| Professional | | $346.06 | $485.80 | $638.14 |