- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.85 / $752.56 / $1,807.81
| Facility | | $520.85 | $752.56 | $1,807.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.85 / $520.85 / $554.52
| Professional | | $520.85 | $520.85 | $554.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.79 / $1,162.51 / $1,960.62
| Facility | | $217.79 | $1,162.51 | $1,960.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.40 / $475.30 / $581.45
| Professional | | $343.40 | $475.30 | $581.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.91 / $2,196.25 / $4,546.24
| Facility | | $514.91 | $2,196.25 | $4,546.24 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $792.17 / $792.17 / $1,025.29
| Professional | | $792.17 | $792.17 | $1,025.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.71 / $689.19 / $1,390.18
| Professional | | $332.71 | $689.19 | $1,390.18 |