- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.07 / $200.40 / $355.16
| Professional | | $156.07 | $200.40 | $355.16 |
- 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
- $298.00 / $451.00 / $748.00
| Professional | | $298.00 | $451.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.61 / $372.67 / $656.12
| Professional | | $216.61 | $372.67 | $656.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $788.00 / $3,328.00
| Facility | | $788.00 | $788.00 | $3,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.30 / $509.87 / $852.81
| Professional | | $279.30 | $509.87 | $852.81 |