- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.16 / $187.09 / $268.14
| Professional | | $161.16 | $187.09 | $268.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.45 / $1,128.72 / $2,040.68
| Facility | | $312.45 | $1,128.72 | $2,040.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.87 / $363.83 / $495.72
| Professional | | $272.87 | $363.83 | $495.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.83 / $302.83 / $302.83
| Facility | | $302.83 | $302.83 | $302.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.41 / $257.41 / $435.38
| Professional | | $257.41 | $257.41 | $435.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.76 / $277.80 / $1,623.77
| Facility | | $109.76 | $277.80 | $1,623.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.66 / $170.01 / $261.98
| Professional | | $153.66 | $170.01 | $261.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.27 / $226.68 / $261.98
| Facility | | $0.27 | $226.68 | $261.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.66 / $170.01 / $256.10
| Professional | | $153.66 | $170.01 | $256.10 |