- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.65 / $922.14 / $1,152.68
| Professional | | $537.65 | $922.14 | $1,152.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.05 / $1,223.23 / $2,160.94
| Professional | | $124.05 | $1,223.23 | $2,160.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.30 / $674.04 / $7,874.71
| Facility | | $105.30 | $674.04 | $7,874.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.41 / $737.83 / $1,167.83
| Professional | | $492.41 | $737.83 | $1,167.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.89 / $737.57 / $1,062.42
| Professional | | $543.89 | $737.57 | $1,062.42 |