- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.52 / $962.71 / $2,315.94
| Facility | | $678.52 | $962.71 | $2,315.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.42 / $657.46 / $1,158.11
| Professional | | $376.42 | $657.46 | $1,158.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.85 / $880.15 / $1,823.58
| Facility | | $558.85 | $880.15 | $1,823.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.48 / $586.37 / $1,057.40
| Professional | | $356.48 | $586.37 | $1,057.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.60 / $312.62 / $492.85
| Facility | | $220.60 | $312.62 | $492.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.00 / $1,633.00 / $1,633.00
| Professional | | $389.00 | $1,633.00 | $1,633.00 |