- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.00 / $630.64 / $788.31
| Professional | | $524.00 | $630.64 | $788.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.03 / $410.46 / $754.49
| Facility | | $155.03 | $410.46 | $754.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.08 / $2,052.00 / $2,052.00
| Professional | | $256.08 | $2,052.00 | $2,052.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.00 / $521.00 / $521.00
| Facility | | $521.00 | $521.00 | $521.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.00 / $528.23 / $540.80
| Professional | | $421.00 | $528.23 | $540.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $468.30
| Professional | | $375.00 | $375.00 | $468.30 |