- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.29 / $1,097.56 / $2,070.87
| Facility | | $690.29 | $1,097.56 | $2,070.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.20 / $517.72 / $586.75
| Professional | | $483.20 | $517.72 | $586.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.25 / $1,013.00 / $2,692.13
| Facility | | $382.25 | $1,013.00 | $2,692.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $335.33 / $814.60
| Professional | | $335.33 | $335.33 | $814.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.04 / $1,166.58 / $2,070.69
| Facility | | $616.04 | $1,166.58 | $2,070.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.98 / $840.98 / $1,007.58
| Professional | | $840.98 | $840.98 | $1,007.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.92 / $414.17 / $793.83
| Professional | | $289.92 | $414.17 | $793.83 |