- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.43 / $73.84 / $92.75
| Professional | | $64.43 | $73.84 | $92.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.26 / $809.18 / $1,183.86
| Facility | | $728.26 | $809.18 | $1,183.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.67 / $79.81 / $110.93
| Professional | | $57.67 | $79.81 | $110.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $1,863.00 / $2,983.88
| Facility | | $1,100.00 | $1,863.00 | $2,983.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.09 / $102.78 / $193.04
| Professional | | $72.09 | $102.78 | $193.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.00 / $840.00 / $900.00
| Facility | | $840.00 | $840.00 | $900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.64 / $84.94 / $123.55
| Professional | | $65.64 | $84.94 | $123.55 |