- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.14 / $801.42 / $1,122.64
| Professional | | $454.14 | $801.42 | $1,122.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.25 / $105.25 / $126.30
| Professional | | $105.25 | $105.25 | $126.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.51 / $606.51 / $1,365.47
| Facility | | $606.51 | $606.51 | $1,365.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.23 / $606.51 / $1,627.50
| Professional | | $122.23 | $606.51 | $1,627.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $140.33 / $203.93
| Professional | | $100.00 | $140.33 | $203.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.88 / $210.50 / $964.53
| Professional | | $157.88 | $210.50 | $964.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.57 / $733.39 / $1,197.89
| Professional | | $668.57 | $733.39 | $1,197.89 |