- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.38 / $478.21 / $555.79
| Professional | | $362.38 | $478.21 | $555.79 |
- 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
- $555.60 / $674.14 / $1,070.43
| Professional | | $555.60 | $674.14 | $1,070.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,123.48 / $1,432.33 / $2,517.94
| Facility | | $1,123.48 | $1,432.33 | $2,517.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.23 / $1,093.01 / $1,547.40
| Professional | | $702.23 | $1,093.01 | $1,547.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.66 / $681.71 / $908.94
| Professional | | $397.66 | $681.71 | $908.94 |