- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.25 / $1,160.26 / $3,140.73
| Facility | | $717.25 | $1,160.26 | $3,140.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.45 / $653.33 / $669.08
| Professional | | $523.45 | $653.33 | $669.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.50 / $1,551.36 / $2,457.57
| Facility | | $408.50 | $1,551.36 | $2,457.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.49 / $751.26 / $3,638.90
| Professional | | $516.49 | $751.26 | $3,638.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.60 / $1,279.13 / $2,302.42
| Facility | | $520.60 | $1,279.13 | $2,302.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.39 / $787.15 / $1,449.32
| Facility | | $527.39 | $787.15 | $1,449.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.60 / $330.60 / $3,920.01
| Professional | | $330.60 | $330.60 | $3,920.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.60 / $330.60 / $472.29
| Professional | | $330.60 | $330.60 | $472.29 |