- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,819.70 / $2,511.89
| Facility | | $295.12 | $1,819.70 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $371.54 / $741.31
| Professional | | $295.12 | $371.54 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $537.03 / $562.34
| Facility | | $512.86 | $537.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $457.09 / $616.60
| Professional | | $346.74 | $457.09 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $758.58 / $2,570.40
| Facility | | $371.54 | $758.58 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $426.58 / $660.69
| Professional | | $316.23 | $426.58 | $660.69 |