- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.04 / $123.45 / $220.47
| Professional | | $98.04 | $123.45 | $220.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,477.00 / $2,365.98 / $2,554.80
| Facility | | $1,477.00 | $2,365.98 | $2,554.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.06 / $328.06 / $328.06
| Professional | | $328.06 | $328.06 | $328.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.13 / $239.17 / $432.15
| Professional | | $137.13 | $239.17 | $432.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.52 / $247.43 / $432.15
| Professional | | $138.52 | $247.43 | $432.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.08 / $360.87 / $676.44
| Professional | | $257.08 | $360.87 | $676.44 |