- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.08 / $753.08 / $1,569.94
| Professional | | $753.08 | $753.08 | $1,569.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.80 / $328.47 / $596.76
| Professional | | $253.80 | $328.47 | $596.76 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $298.01 / $392.86 / $702.05
| Professional | 22 | $298.01 | $392.86 | $702.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.65 / $389.25 / $751.07
| Professional | | $232.65 | $389.25 | $751.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.85 / $392.55 / $1,227.96
| Facility | | $130.85 | $392.55 | $1,227.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.88 / $467.22 / $654.91
| Professional | | $255.88 | $467.22 | $654.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.88 / $467.22 / $654.91
| Professional | | $255.88 | $467.22 | $654.91 |