- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.36 / $1,032.63 / $2,795.23
| Facility | | $638.36 | $1,032.63 | $2,795.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.41 / $581.46 / $595.48
| Professional | | $525.41 | $581.46 | $595.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.81 / $1,833.55 / $2,904.61
| Facility | | $482.81 | $1,833.55 | $2,904.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.67 / $668.62 / $3,238.61
| Professional | | $459.67 | $668.62 | $3,238.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $469.38 / $700.56 / $1,279.23
| Facility | | $469.38 | $700.56 | $1,279.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.24 / $294.24 / $3,488.79
| Professional | | $294.24 | $294.24 | $3,488.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.24 / $294.24 / $420.34
| Professional | | $294.24 | $294.24 | $420.34 |