- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.07 / $748.39 / $2,877.26
| Facility | | $492.07 | $748.39 | $2,877.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.65 / $492.07 / $523.87
| Professional | | $396.65 | $492.07 | $523.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.69 / $1,098.26 / $1,852.27
| Facility | | $362.69 | $1,098.26 | $1,852.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.67 / $928.82 / $1,170.08
| Professional | | $381.67 | $928.82 | $1,170.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.36 / $2,407.09 / $4,296.29
| Facility | | $1,118.36 | $2,407.09 | $4,296.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.65 / $1,363.57 / $1,848.52
| Professional | | $860.65 | $1,363.57 | $1,848.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.26 / $449.03 / $1,313.35
| Professional | | $344.26 | $449.03 | $1,313.35 |