- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.05 / $1,221.17 / $4,451.21
| Facility | | $897.05 | $1,221.17 | $4,451.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.76 / $1,007.06 / $1,100.15
| Professional | | $507.76 | $1,007.06 | $1,100.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.34 / $1,652.68 / $2,604.14
| Facility | | $916.34 | $1,652.68 | $2,604.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.64 / $930.90 / $939.36
| Professional | | $761.64 | $930.90 | $939.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.27 / $846.27 / $846.27
| Facility | | $846.27 | $846.27 | $846.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.08 / $681.55 / $6,424.32
| Facility | | $550.08 | $681.55 | $6,424.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $455.66 / $1,184.78
| Professional | | $355.43 | $455.66 | $1,184.78 |