- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.97 / $302.19 / $1,113.48
| Professional | | $164.97 | $302.19 | $1,113.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.57 / $2,946.11 / $3,080.28
| Facility | | $1,342.57 | $2,946.11 | $3,080.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.83 / $289.83 / $289.83
| Facility | | $289.83 | $289.83 | $289.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.03 / $317.13 / $432.20
| Professional | | $120.03 | $317.13 | $432.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.83 / $289.83 / $289.83
| Facility | | $289.83 | $289.83 | $289.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.03 / $317.13 / $432.20
| Professional | | $120.03 | $317.13 | $432.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.06 / $241.96 / $400.09
| Professional | | $108.06 | $241.96 | $400.09 |