- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.44 / $290.22 / $1,116.63
| Professional | | $158.44 | $290.22 | $1,116.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.00 / $1,289.44 / $2,958.15
| Facility | | $685.00 | $1,289.44 | $2,958.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.67 / $290.67 / $721.40
| Facility | | $290.67 | $290.67 | $721.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.23 / $311.74 / $734.65
| Professional | | $115.23 | $311.74 | $734.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.67 / $290.67 / $721.40
| Facility | | $290.67 | $290.67 | $721.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.47 / $311.74 / $734.65
| Professional | | $133.47 | $311.74 | $734.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.36 / $242.84 / $401.22
| Professional | | $108.36 | $242.84 | $401.22 |