- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $5.81 / $631.16
| Professional | | $5.81 | $5.81 | $631.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.77 / $430.77 / $430.77
| Facility | | $430.77 | $430.77 | $430.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.44 / $96.80 / $130.40
| Professional | | $77.44 | $96.80 | $130.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,447.05 / $16,560.59 / $23,360.53
| Facility | | $15,447.05 | $16,560.59 | $23,360.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.24 / $473.24 / $473.24
| Facility | | $473.24 | $473.24 | $473.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.61 / $127.78 / $533.75
| Professional | | $108.61 | $127.78 | $533.75 |