- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.20 / $227.20 / $1,170.59
| Professional | | $227.20 | $227.20 | $1,170.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.89 / $1,197.07 / $1,994.73
| Facility | | $304.89 | $1,197.07 | $1,994.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.39 / $370.02 / $737.72
| Professional | | $254.39 | $370.02 | $737.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.00 / $170.00 / $170.00
| Professional | | $170.00 | $170.00 | $170.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.76 / $405.72 / $1,898.77
| Facility | | $129.76 | $405.72 | $1,898.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.81 / $308.47 / $507.21
| Professional | | $202.81 | $308.47 | $507.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.83 / $320.20 / $507.21
| Professional | | $266.83 | $320.20 | $507.21 |