- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.41 / $189.41 / $255.85
| Professional | | $189.41 | $189.41 | $255.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $465.00 / $697.00
| Professional | | $350.00 | $465.00 | $697.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.08 / $315.92 / $450.62
| Professional | | $225.08 | $315.92 | $450.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.14 / $564.30 / $756.38
| Professional | | $282.14 | $564.30 | $756.38 |