- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $478.63 / $1,071.52
| Professional | | $186.21 | $478.63 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $204.17 / $234.42
| Professional | | $186.21 | $204.17 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $489.78 / $1,258.93
| Professional | | $194.98 | $489.78 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $794.33
| Professional | | $489.78 | $575.44 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $501.19 / $1,621.81
| Facility | | $371.54 | $501.19 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $457.09 / $851.14
| Professional | | $190.55 | $457.09 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $758.58
| Professional | | $426.58 | $602.56 | $758.58 |