- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.99 / $123.63 / $288.14
| Professional | | $116.99 | $123.63 | $288.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,228.64 / $1,368.33 / $4,858.28
| Facility | | $1,228.64 | $1,368.33 | $4,858.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.58 / $160.13 / $309.30
| Professional | | $142.58 | $160.13 | $309.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.93 / $1,981.08 / $3,482.61
| Facility | | $380.93 | $1,981.08 | $3,482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.61 / $241.11 / $367.31
| Professional | | $129.61 | $241.11 | $367.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.66 / $238.62 / $568.76
| Professional | | $147.66 | $238.62 | $568.76 |