- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.31 / $888.15 / $2,559.42
| Professional | | $228.31 | $888.15 | $2,559.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.25 / $331.25 / $331.25
| Facility | | $331.25 | $331.25 | $331.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.75 / $354.06 / $816.31
| Professional | | $188.75 | $354.06 | $816.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.34 / $331.25 / $590.72
| Facility | | $163.34 | $331.25 | $590.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.56 / $550.99 / $1,137.78
| Professional | | $281.56 | $550.99 | $1,137.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.90 / $767.76 / $868.94
| Professional | | $582.90 | $767.76 | $868.94 |