- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.83 / $548.52 / $770.08
| Professional | | $310.83 | $548.52 | $770.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.20 / $72.20 / $72.20
| Professional | | $72.20 | $72.20 | $72.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.33 / $458.33 / $919.13
| Facility | | $458.33 | $458.33 | $919.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.44 / $458.33 / $1,117.50
| Professional | | $82.44 | $458.33 | $1,117.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.23 / $100.00 / $200.00
| Professional | | $97.23 | $100.00 | $200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.30 / $144.38 / $1,041.58
| Professional | | $108.30 | $144.38 | $1,041.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.76 / $698.16 / $1,069.59
| Professional | | $470.76 | $698.16 | $1,069.59 |