- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $831.76 / $1,949.84
| Professional | | $501.19 | $831.76 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $288.40 / $602.56
| Facility | | $257.04 | $288.40 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,548.82
| Professional | | $891.25 | $891.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $512.86 / $691.83
| Facility | | $177.83 | $512.86 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $912.01
| Professional | | $741.31 | $741.31 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $426.58 / $575.44
| Professional | | $102.33 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $501.19 / $2,089.30
| Professional | | $102.33 | $501.19 | $2,089.30 |