- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.62 / $836.16 / $1,114.88
| Facility | | $544.62 | $836.16 | $1,114.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.62 / $557.44 / $621.51
| Professional | | $544.62 | $557.44 | $621.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $440.82 / $1,180.65
| Professional | | $208.00 | $440.82 | $1,180.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $904.57 / $1,343.95 / $1,527.20
| Facility | | $904.57 | $1,343.95 | $1,527.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.63 / $675.31 / $835.78
| Professional | | $668.63 | $675.31 | $835.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.58 / $832.95 / $3,043.47
| Facility | | $512.58 | $832.95 | $3,043.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.11 / $384.44 / $724.02
| Professional | | $269.11 | $384.44 | $724.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.11 / $384.44 / $768.88
| Professional | | $269.11 | $384.44 | $768.88 |