- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.50 / $504.56 / $504.56
| Professional | | $366.50 | $504.56 | $504.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.45 / $24.45 / $30.56
| Facility | | $24.45 | $24.45 | $30.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.74 / $635.65 / $1,056.76
| Professional | | $476.74 | $635.65 | $1,056.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.81 / $407.81 / $407.81
| Facility | | $407.81 | $407.81 | $407.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.24 / $407.81 / $815.63
| Professional | | $47.24 | $407.81 | $815.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $370.58 / $2,978.91
| Facility | | $100.00 | $370.58 | $2,978.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.22 / $279.33 / $366.02
| Professional | | $186.22 | $279.33 | $366.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.22 / $279.33 / $366.02
| Professional | | $186.22 | $279.33 | $366.02 |