- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.38 / $418.38 / $522.97
| Professional | | $418.38 | $418.38 | $522.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $435.00 / $1,697.00
| Facility | | $55.00 | $435.00 | $1,697.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.11 / $460.00 / $1,438.25
| Professional | | $389.11 | $460.00 | $1,438.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.96 / $296.74 / $435.00
| Facility | | $228.96 | $296.74 | $435.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.72 / $403.16 / $515.01
| Professional | | $234.72 | $403.16 | $515.01 |