- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.72 / $282.72 / $282.72
| Professional | | $282.72 | $282.72 | $282.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.00 / $2,971.00 / $7,022.00
| Facility | | $1,974.00 | $2,971.00 | $7,022.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.76 / $75.12 / $110.48
| Professional | | $60.76 | $75.12 | $110.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.30 / $80.91 / $360.38
| Facility | | $62.30 | $80.91 | $360.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.62 / $86.44 / $111.14
| Professional | | $60.62 | $86.44 | $111.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.94 / $101.92 / $246.11
| Professional | | $64.94 | $101.92 | $246.11 |