- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $3,235.94 / $8,912.51
| Professional | | $524.81 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Professional | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $177.83
| Professional | | $169.82 | $169.82 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $691.83
| Facility | | $257.04 | $257.04 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $3,235.94 / $8,912.51
| Professional | | $512.86 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $79.43 / $79.43
| Professional | | $70.79 | $79.43 | $79.43 |