- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $794.33 / $1,288.25
| Professional | | $316.23 | $794.33 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $251.19 / $478.63
| Professional | | $218.78 | $251.19 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $19,498.45
| Facility | | $2,398.83 | $2,398.83 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |