- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.07 / $1,481.30 / $2,532.14
| Facility | | $1,266.07 | $1,481.30 | $2,532.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.16 / $1,481.30 / $1,481.30
| Professional | | $1,076.16 | $1,481.30 | $1,481.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.89 / $652.76 / $878.17
| Facility | | $537.89 | $652.76 | $878.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.21 / $448.43 / $721.64
| Professional | | $369.21 | $448.43 | $721.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.95 / $1,028.69 / $2,740.42
| Facility | | $822.95 | $1,028.69 | $2,740.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $531.75 / $1,266.07
| Professional | | $531.75 | $531.75 | $1,266.07 |