- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.12 / $139.91 / $156.16
| Professional | | $98.12 | $139.91 | $156.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $1,966.73 / $3,323.11
| Facility | | $582.00 | $1,966.73 | $3,323.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.62 / $294.62 / $679.76
| Professional | | $294.62 | $294.62 | $679.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.18 / $174.21 / $227.24
| Professional | | $135.18 | $174.21 | $227.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.00 / $525.00 / $1,330.00
| Facility | | $418.00 | $525.00 | $1,330.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.80 / $161.68 / $272.83
| Professional | | $124.80 | $161.68 | $272.83 |