- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $645.65 / $1,047.13
| Professional | | $257.04 | $645.65 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $239.88 / $371.54
| Facility | | $177.83 | $239.88 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $154.88 / $371.54
| Professional | | $5.01 | $154.88 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $50,118.72 / $50,118.72
| Facility | | $7,762.47 | $50,118.72 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,862.09 / $1,862.09
| Professional | | $1,698.24 | $1,862.09 | $1,862.09 |