- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.33 / $1,137.65 / $1,963.35
| Facility | | $719.33 | $1,137.65 | $1,963.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.16 / $736.25 / $973.21
| Professional | | $643.16 | $736.25 | $973.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.51 / $755.29 / $1,498.87
| Professional | | $338.51 | $755.29 | $1,498.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.61 / $1,634.29 / $2,017.14
| Facility | | $1,165.61 | $1,634.29 | $2,017.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.92 / $981.92 / $981.92
| Professional | | $981.92 | $981.92 | $981.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.33 / $1,015.52 / $4,019.78
| Facility | | $719.33 | $1,015.52 | $4,019.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $507.76 / $4,214.42
| Professional | | $355.43 | $507.76 | $4,214.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.43 / $507.76 / $957.13
| Professional | | $355.43 | $507.76 | $957.13 |