- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.09 / $1,025.46 / $1,202.84
| Professional | | $581.09 | $1,025.46 | $1,202.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.16 / $134.66 / $134.66
| Professional | | $89.16 | $134.66 | $134.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.04 / $860.04 / $1,485.22
| Facility | | $860.04 | $860.04 | $1,485.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.22 / $860.04 / $2,081.25
| Professional | | $702.22 | $860.04 | $2,081.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $200.00 / $221.76
| Professional | | $100.00 | $200.00 | $221.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.01 / $202.01 / $269.33
| Professional | | $202.01 | $202.01 | $269.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.65 / $755.72 / $1,259.53
| Professional | | $553.65 | $755.72 | $1,259.53 |