- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.10 / $791.69 / $2,111.83
| Facility | | $721.10 | $791.69 | $2,111.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.30 / $499.08 / $531.34
| Professional | | $402.30 | $499.08 | $531.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.05 / $920.04 / $1,878.65
| Facility | | $122.05 | $920.04 | $1,878.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.04 / $455.43 / $1,059.85
| Professional | | $329.04 | $455.43 | $1,059.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.81 / $1,624.07 / $3,099.77
| Facility | | $759.81 | $1,624.07 | $3,099.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.91 / $1,382.99 / $1,874.85
| Professional | | $872.91 | $1,382.99 | $1,874.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.16 / $455.43 / $1,332.06
| Professional | | $349.16 | $455.43 | $1,332.06 |