- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.80 / $234.50 / $1,456.92
| Professional | | $167.80 | $234.50 | $1,456.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.70 / $996.08 / $1,433.61
| Facility | | $314.70 | $996.08 | $1,433.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $952.00 / $3,174.88 / $3,174.88
| Professional | | $952.00 | $3,174.88 | $3,174.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.00 / $970.00 / $970.00
| Facility | | $970.00 | $970.00 | $970.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.00 / $981.31 / $1,091.05
| Professional | | $530.00 | $981.31 | $1,091.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.45 / $858.70 / $948.37
| Professional | | $308.45 | $858.70 | $948.37 |