- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.10 / $793.11 / $1,544.49
| Professional | | $422.10 | $793.11 | $1,544.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.50 / $11,500.00 / $12,000.00
| Facility | | $510.50 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,460.17 / $1,460.17
| Professional | | $1,350.00 | $1,460.17 | $1,460.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.98 / $323.87 / $508.23
| Facility | | $203.98 | $323.87 | $508.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $372.00 / $757.10
| Professional | | $5.00 | $372.00 | $757.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.19 / $324.02 / $525.60
| Facility | | $206.19 | $324.02 | $525.60 |