- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $323.59 / $1,071.52
| Professional | | $263.03 | $323.59 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,380.38 / $1,380.38
| Facility | | $1,122.02 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $426.58 / $562.34
| Professional | | $295.12 | $426.58 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $562.34 / $812.83
| Professional | | $213.80 | $562.34 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $426.58 / $831.76
| Professional | | $363.08 | $426.58 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $1,071.52
| Professional | | $281.84 | $389.05 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $467.74 / $831.76
| Professional | | $309.03 | $467.74 | $831.76 |