- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.84 / $1,161.34 / $3,028.61
| Facility | | $584.84 | $1,161.34 | $3,028.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.77 / $569.29 / $645.19
| Professional | | $504.77 | $569.29 | $645.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.78 / $1,753.70 / $2,778.10
| Facility | | $461.78 | $1,753.70 | $2,778.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.65 / $639.49 / $3,097.52
| Professional | | $439.65 | $639.49 | $3,097.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.87 / $1,184.10 / $2,121.53
| Facility | | $440.87 | $1,184.10 | $2,121.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.56 / $759.05 / $1,445.02
| Facility | | $508.56 | $759.05 | $1,445.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $318.80 / $3,780.07
| Professional | | $318.80 | $318.80 | $3,780.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $318.80 / $455.43
| Professional | | $318.80 | $318.80 | $455.43 |