- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.33 / $802.86 / $2,241.71
| Facility | | $521.33 | $802.86 | $2,241.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.33 / $1,011.26 / $1,646.89
| Professional | | $521.33 | $1,011.26 | $1,646.89 |
- 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 / $777.23
| Professional | | $335.11 | $457.08 | $777.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.77 / $921.21 / $1,615.36
| Facility | | $635.77 | $921.21 | $1,615.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.58 / $391.00 / $596.85
| Professional | | $273.58 | $391.00 | $596.85 |