- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.83 / $536.38 / $922.26
| Professional | | $356.83 | $536.38 | $922.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.61 / $385.97 / $594.48
| Facility | | $230.61 | $385.97 | $594.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,460.17 / $1,460.17
| Professional | | $1,350.00 | $1,460.17 | $1,460.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.00 / $487.00 / $487.00
| Facility | | $487.00 | $487.00 | $487.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.63 / $445.00 / $678.91
| Professional | | $387.63 | $445.00 | $678.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.61 / $284.61 / $417.28
| Professional | | $284.61 | $284.61 | $417.28 |