- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $588.84 / $1,318.26
| Professional | | $426.58 | $588.84 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $1,905.46
| Professional | | $562.34 | $562.34 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $707.95 / $1,174.90
| Professional | | $346.74 | $707.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $1,698.24
| Professional | | $512.86 | $645.65 | $1,698.24 |