- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.51 / $466.17 / $1,063.84
| Facility | | $306.51 | $466.17 | $1,063.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.07 / $306.51 / $326.32
| Professional | | $247.07 | $306.51 | $326.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.67 / $684.10 / $1,153.77
| Facility | | $457.67 | $684.10 | $1,153.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.74 / $1,922.11 / $2,828.25
| Professional | | $237.74 | $1,922.11 | $2,828.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.01 / $1,499.38 / $2,676.26
| Facility | | $303.01 | $1,499.38 | $2,676.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.10 / $849.36 / $1,151.44
| Professional | | $536.10 | $849.36 | $1,151.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.79 / $287.81 / $818.08
| Professional | | $195.79 | $287.81 | $818.08 |