- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.71 / $200.09 / $365.87
| Professional | | $156.71 | $200.09 | $365.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,385.60 / $1,385.60 / $1,385.60
| Facility | | $1,385.60 | $1,385.60 | $1,385.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $454.00 / $777.00
| Professional | | $300.00 | $454.00 | $777.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.28 / $367.90 / $661.16
| Professional | | $214.28 | $367.90 | $661.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.35 / $522.39 / $847.59
| Professional | | $311.35 | $522.39 | $847.59 |