- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.51 / $657.14 / $823.33
| Professional | | $634.51 | $657.14 | $823.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.50 / $709.12 / $3,195.24
| Facility | | $612.50 | $709.12 | $3,195.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.30 / $416.30 / $520.38
| Professional | | $416.30 | $416.30 | $520.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.14 / $657.14 / $841.14
| Facility | | $657.14 | $657.14 | $841.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $78.00
| Professional | | $55.00 | $55.00 | $78.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.23 / $1,933.52 / $2,605.34
| Facility | | $978.23 | $1,933.52 | $2,605.34 |