- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.68 / $306.38 / $1,962.46
| Professional | | $270.68 | $306.38 | $1,962.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.14 / $510.14 / $578.15
| Professional | | $510.14 | $510.14 | $578.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.58 / $645.11 / $1,166.32
| Facility | | $178.58 | $645.11 | $1,166.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.63 / $595.24 / $766.37
| Professional | | $483.63 | $595.24 | $766.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.45 / $361.45 / $361.45
| Facility | | $361.45 | $361.45 | $361.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.86 / $263.86 / $788.63
| Professional | | $263.86 | $263.86 | $788.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.30 / $454.48 / $2,665.73
| Facility | | $164.30 | $454.48 | $2,665.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.79 / $254.50 / $383.37
| Professional | | $229.79 | $254.50 | $383.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.79 / $254.50 / $383.37
| Professional | | $229.79 | $254.50 | $383.37 |