- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.82 / $1,395.48 / $2,286.21
| Facility | | $593.82 | $1,395.48 | $2,286.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.59 / $593.82 / $608.66
| Professional | | $519.59 | $593.82 | $608.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.20 / $825.05 / $1,476.15
| Professional | | $699.20 | $825.05 | $1,476.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.27 / $2,171.14 / $21,340.86
| Facility | | $742.27 | $2,171.14 | $21,340.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.03 / $1,781.45 / $17,460.71
| Professional | | $776.03 | $1,781.45 | $17,460.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.34 / $1,563.24 / $5,004.33
| Facility | | $844.34 | $1,563.24 | $5,004.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.34 / $1,563.24 / $5,004.33
| Facility | | $844.34 | $1,563.24 | $5,004.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.75 / $445.36 / $980.32
| Professional | | $311.75 | $445.36 | $980.32 |