- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.49 / $685.15 / $1,328.37
| Professional | | $268.49 | $685.15 | $1,328.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,197.38 / $3,616.69
| Facility | | $587.35 | $2,197.38 | $3,616.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.37 / $167.65 / $251.47
| Professional | | $119.37 | $167.65 | $251.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.39 / $251.10 / $2,056.00
| Facility | | $123.39 | $251.10 | $2,056.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.50 / $304.50 / $1,791.04
| Professional | | $217.50 | $304.50 | $1,791.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.16 / $255.25 / $469.23
| Professional | | $188.16 | $255.25 | $469.23 |