- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.64 / $1,067.54 / $1,736.35
| Professional | | $886.64 | $1,067.54 | $1,736.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.77 / $397.61 / $622.00
| Facility | | $291.77 | $397.61 | $622.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.00 / $383.00 / $383.00
| Professional | | $383.00 | $383.00 | $383.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $293.89 / $534.29
| Professional | | $5.00 | $293.89 | $534.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.39 / $7,738.55 / $12,000.00
| Facility | | $751.39 | $7,738.55 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,329.00 / $2,550.73 / $2,550.73
| Professional | | $2,329.00 | $2,550.73 | $2,550.73 |