- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.36 / $601.62 / $1,128.09
| Professional | | $506.36 | $601.62 | $1,128.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.16 / $768.71 / $1,967.65
| Professional | | $82.16 | $768.71 | $1,967.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.28 / $120.35 / $1,025.31
| Facility | | $96.28 | $120.35 | $1,025.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.35 / $120.35 / $120.35
| Professional | | $120.35 | $120.35 | $120.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.45 / $344.45 / $344.45
| Facility | | $344.45 | $344.45 | $344.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.06 / $344.45 / $1,642.50
| Professional | | $100.06 | $344.45 | $1,642.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.56 / $1,290.85 / $3,098.00
| Professional | | $137.56 | $1,290.85 | $3,098.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.24 / $560.09 / $834.39
| Professional | | $357.24 | $560.09 | $834.39 |