- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.96 / $255.15 / $320.02
| Professional | | $244.96 | $255.15 | $320.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.60 / $1,373.60 / $1,373.60
| Facility | | $1,373.60 | $1,373.60 | $1,373.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.00 / $483.00 / $730.00
| Professional | | $479.00 | $483.00 | $730.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.13 / $474.46 / $708.91
| Professional | | $312.13 | $474.46 | $708.91 |
- 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
- $242.82 / $473.64 / $736.23
| Professional | | $242.82 | $473.64 | $736.23 |