- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.25 / $282.85 / $1,212.51
| Professional | | $171.25 | $282.85 | $1,212.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.06 / $1,393.69 / $3,197.22
| Facility | | $911.06 | $1,393.69 | $3,197.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.62 / $315.62 / $959.40
| Facility | | $315.62 | $315.62 | $959.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.49 / $336.86 / $797.72
| Professional | | $124.49 | $336.86 | $797.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.62 / $315.62 / $959.40
| Facility | | $315.62 | $315.62 | $959.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.27 / $336.86 / $797.72
| Professional | | $144.27 | $336.86 | $797.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.67 / $262.47 / $435.67
| Professional | | $117.67 | $262.47 | $435.67 |