- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.52 / $1,074.38 / $2,190.81
| Facility | | $655.52 | $1,074.38 | $2,190.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.21 / $645.62 / $744.64
| Professional | | $586.21 | $645.62 | $744.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.86 / $1,162.51 / $3,089.46
| Facility | | $422.86 | $1,162.51 | $3,089.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.36 / $211.42 / $581.45
| Professional | | $201.36 | $211.42 | $581.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.04 / $1,040.11 / $2,188.37
| Facility | | $623.04 | $1,040.11 | $2,188.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.25 / $910.25 / $1,137.82
| Professional | | $910.25 | $910.25 | $1,137.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.17 / $792.17 / $792.17
| Facility | | $792.17 | $792.17 | $792.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.71 / $475.30 / $871.39
| Professional | | $332.71 | $475.30 | $871.39 |