- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.72 / $1,077.38 / $2,591.78
| Facility | | $759.72 | $1,077.38 | $2,591.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.28 / $833.38 / $1,297.74
| Professional | | $519.28 | $833.38 | $1,297.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.60 / $984.98 / $2,040.78
| Facility | | $617.60 | $984.98 | $2,040.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.57 / $737.11 / $1,219.77
| Professional | | $477.57 | $737.11 | $1,219.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.44 / $379.25 / $645.29
| Facility | | $309.44 | $379.25 | $645.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.29 / $1,434.72 / $1,434.72
| Professional | | $1,200.29 | $1,434.72 | $1,434.72 |