- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.94 / $1,379.42 / $3,122.73
| Facility | | $693.94 | $1,379.42 | $3,122.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.24 / $693.94 / $719.33
| Professional | | $626.24 | $693.94 | $719.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.51 / $2,538.81 / $4,594.39
| Facility | | $338.51 | $2,538.81 | $4,594.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.73 / $338.51 / $677.02
| Professional | | $287.73 | $338.51 | $677.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.27 / $1,100.15 / $1,650.23
| Facility | | $846.27 | $1,100.15 | $1,650.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $1,015.52 / $1,269.41
| Professional | | $846.27 | $1,015.52 | $1,269.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.08 / $1,599.29 / $3,299.75
| Facility | | $550.08 | $1,599.29 | $3,299.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.83 / $972.20 / $1,234.70
| Professional | | $446.83 | $972.20 | $1,234.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $507.76 / $930.05
| Professional | | $355.43 | $507.76 | $930.05 |