- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.44 / $798.39 / $2,229.29
| Facility | | $518.44 | $798.39 | $2,229.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.44 / $1,005.44 / $1,637.75
| Professional | | $518.44 | $1,005.44 | $1,637.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.35 / $993.44 / $1,564.12
| Facility | | $588.35 | $993.44 | $1,564.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.11 / $457.08 / $706.57
| Professional | | $335.11 | $457.08 | $706.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.22 / $381.89 / $714.46
| Professional | | $259.22 | $381.89 | $714.46 |