- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,445.44 / $2,238.72
| Facility | | $758.58 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $457.09 / $794.33
| Professional | | $288.40 | $457.09 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,884.03 / $3,890.45
| Facility | | $2,454.71 | $2,884.03 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $630.96 / $741.31
| Professional | | $436.52 | $630.96 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $512.86 / $1,148.15
| Professional | | $288.40 | $512.86 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,951.21 / $4,168.69
| Facility | | $831.76 | $2,951.21 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $380.19 / $512.86
| Professional | | $263.03 | $380.19 | $512.86 |