- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.63 / $741.64 / $2,851.31
| Facility | | $487.63 | $741.64 | $2,851.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.07 / $487.63 / $519.15
| Professional | | $393.07 | $487.63 | $519.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.69 / $1,088.35 / $1,835.56
| Facility | | $362.69 | $1,088.35 | $1,835.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.23 / $920.44 / $1,170.08
| Professional | | $378.23 | $920.44 | $1,170.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.89 / $1,351.27 / $1,831.85
| Professional | | $852.89 | $1,351.27 | $1,831.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.49 / $444.98 / $1,301.50
| Professional | | $311.49 | $444.98 | $1,301.50 |