- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.31 / $1,013.35 / $2,642.66
| Facility | | $510.31 | $1,013.35 | $2,642.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.44 / $549.73 / $562.97
| Professional | | $440.44 | $549.73 | $562.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.45 / $1,733.48 / $2,746.07
| Facility | | $456.45 | $1,733.48 | $2,746.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.58 / $632.12 / $3,061.83
| Professional | | $434.58 | $632.12 | $3,061.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.57 / $459.94 / $1,209.73
| Facility | | $363.57 | $459.94 | $1,209.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.75 / $662.32 / $1,299.74
| Facility | | $443.75 | $662.32 | $1,299.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.17 / $278.17 / $3,298.35
| Professional | | $278.17 | $278.17 | $3,298.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.17 / $278.17 / $397.39
| Professional | | $278.17 | $278.17 | $397.39 |