- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.47 / $1,047.30 / $1,445.22
| Professional | | $593.47 | $1,047.30 | $1,445.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.95 / $137.54 / $137.54
| Professional | | $85.95 | $137.54 | $137.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.03 / $511.03 / $1,516.87
| Facility | | $511.03 | $511.03 | $1,516.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.10 / $511.03 / $1,807.50
| Professional | | $136.10 | $511.03 | $1,807.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $200.00 / $222.65
| Professional | | $100.00 | $200.00 | $222.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.31 / $206.31 / $275.08
| Professional | | $206.31 | $206.31 | $275.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.95 / $771.74 / $1,265.38
| Professional | | $594.95 | $771.74 | $1,265.38 |