- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.33 / $634.10 / $1,846.49
| Facility | | $534.33 | $634.10 | $1,846.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.57 / $574.91 / $574.91
| Professional | | $573.57 | $574.91 | $574.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.71 / $892.81 / $1,332.45
| Professional | | $351.71 | $892.81 | $1,332.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.68 / $1,392.60 / $2,415.48
| Facility | | $386.68 | $1,392.60 | $2,415.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.37 / $676.37 / $3,260.10
| Professional | | $676.37 | $676.37 | $3,260.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.88 / $3,212.76 / $3,212.76
| Facility | | $1,176.88 | $3,212.76 | $3,212.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,381.85 / $3,381.85 / $5,072.78
| Professional | | $3,381.85 | $3,381.85 | $5,072.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.08 / $405.82 / $676.37
| Professional | | $284.08 | $405.82 | $676.37 |