- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.66 / $358.35 / $414.38
| Professional | | $274.66 | $358.35 | $414.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.18 / $1,151.29 / $1,279.21
| Facility | | $883.18 | $1,151.29 | $1,279.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.47 / $512.83 / $809.97
| Professional | | $368.47 | $512.83 | $809.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.77 / $1,432.33 / $2,517.94
| Facility | | $980.77 | $1,432.33 | $2,517.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.20 / $825.81 / $1,182.08
| Professional | | $534.20 | $825.81 | $1,182.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.27 / $393.85 / $686.75
| Professional | | $252.27 | $393.85 | $686.75 |