- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.36 / $308.39 / $1,699.71
| Professional | | $168.36 | $308.39 | $1,699.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.78 / $1,370.20 / $3,143.90
| Facility | | $439.78 | $1,370.20 | $3,143.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.44 / $442.44 / $463.20
| Facility | | $442.44 | $442.44 | $463.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.43 / $323.77 / $593.55
| Professional | | $122.43 | $323.77 | $593.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.44 / $442.44 / $463.20
| Facility | | $442.44 | $442.44 | $463.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.43 / $323.77 / $593.55
| Professional | | $122.43 | $323.77 | $593.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.60 / $264.33 / $610.73
| Professional | | $158.60 | $264.33 | $610.73 |