- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.55 / $181.43 / $689.48
| Professional | | $73.55 | $181.43 | $689.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,752.10 / $3,752.10 / $4,446.32
| Facility | | $3,752.10 | $3,752.10 | $4,446.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.04 / $411.44 / $928.28
| Professional | | $349.04 | $411.44 | $928.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.97 / $304.23 / $928.28
| Professional | | $172.97 | $304.23 | $928.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.54 / $385.94 / $928.28
| Professional | | $197.54 | $385.94 | $928.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.68 / $432.70 / $1,139.35
| Professional | | $339.68 | $432.70 | $1,139.35 |